(WNY News Now) – New York Attorney General Letitia James reveals a damning report exposing the alarming shortcomings in mental health care accessibility facilitated by insurance providers.
New York – The Office of the Attorney General (OAG) surveyed nearly 400 mental health providers listed on health plans’ networks and found that the overwhelming majority, 86 percent, were “ghosts,” meaning they were unreachable, not-in-network, or not accepting new patients. Inaccurate network directories are worsening the statewide mental health crisis and disproportionately impact marginalized communities, leading to adverse health outcomes, and increasing costs for patients. Today’s report follows Attorney General James’ mental health hearings across the state and offers recommendations to increase access to mental health care.
“No one who reaches out to mental health professionals listed by their insurance company should be told that the providers are unreachable, not accepting their insurance, or not accepting new patients,” said Attorney General James. “Our state is facing a mental health crisis, and this report clearly shows that insurance companies are failing to help New Yorkers in need. By not maintaining accurate directories as required by law, health plans are making it harder for New Yorkers, especially the most vulnerable among us, to get mental health care and forcing them to delay or forego the care they need. I am calling on health plans to rapidly address this problem and help us tackle the mental health care crisis.”
Attorney General James held mental health hearings in New York City and Buffalo in June 2022 and January 2023 to help highlight the crisis impacting residents throughout the state. In both hearings, more than 100 patients and providers described a broken system. Parents told OAG they spent months trying to find a provider through their insurance plan but could not find one, which led to their children experiencing worsened conditions.
Following the hearings, OAG staff conducted a statewide review of 13 health plans: Aetna, CDPHP, Cigna, Emblem, Empire BlueCross BlueShield, Excellus, Fidelis, Healthfirst, Independent Health, MetroPlus, Molina, MVP, and UnitedHealthcare. Callers attempted to schedule an appointment for an adult or child with a mental health provider who was listed as accepting new patients. Of the 396 providers called across all plans, only 56 providers, or 14 percent of those contacted, offered appointments. 86 percent of the listed, in-network mental health providers staff called were ghosts, as they were unreachable, not in-network, or not accepting new patients.
Impact of “Ghost Networks” on New Yorkers
New Yorkers struggling with mental health conditions rely on health plan provider directories to access affordable, quality health care services. However, when provider directories contain inaccurate listings or unavailable providers — known as ghost networks — patients may be unable to access treatment using their health insurance benefits. As a result, they are forced to choose between paying out-of-pocket, which is not possible for many, or forgoing treatment altogether.
Ghost networks are particularly harmful to New York’s most vulnerable residents, including low-income individuals, people of color, individuals with disabilities, and women, who are least able to aﬀord the cost of out-of-network care.
At the OAG mental health hearing in Buffalo, a Black parent from Rochester testified about her struggle to find appropriate and culturally responsive care for her child, describing a tangled and deeply inequitable system. Because they were unable to find appropriate care, she and her child endured eight to 10 psychiatric emergency room visits, more than 15 mental hygiene arrests, and countless referrals, meetings, and six-month wait lists over three years.
At the OAG mental health hearing held in New York City, a woman provided testimony that after treatment for depression in the emergency room at Bellevue Hospital, she was told that she would be referred to a therapist in a clinic that would accept Medicaid. However, she could not access treatment with any of the providers to whom she was referred, as they either did not return her calls or had long waiting lists. A mother provided testimony that she was unable to obtain in-network treatment for her elementary school-age child, who suffers from Attention Deficit Hyperactivity Disorder.
In 2022 a mother filed a complaint with OAG that she was unable to find an in-network psychiatrist who could provide psychotherapy for her 14-year-old Black son, who suffers from major depression and attention-deficit disorder. Carelon, which administers mental health benefits for the mother’s insurer, EmblemHealth, gave her a list of eight in-network providers. She called all of them, but none were accepting new patients, provided both psychiatry and psychotherapy, or were culturally competent to treat a patient of color. After OAG intervened, the plan entered into a single-case agreement with an appropriate provider.
These cases reported to OAG demonstrate the real barriers New Yorkers face in accessing a mental health care provider because insurers are not maintaining up to date directories.
To address this crisis and ensure that New Yorkers with mental health conditions have access to affordable and necessary treatment, major action is needed. State agencies must propose regulations for network adequacy for mental health and substance use disorder treatment services by December 31, 2023. The OAG report recommends that:
- State regulators, such as the Department of Health (DOH), the Office of Mental Health, and the Department of Financial Services, should actively and frequently monitor health insurance networks through secret shopper surveys and other techniques to ensure that their directories are up to date. In particular, health plans should be required to ensure that members can get an appointment with an in-network provider within a short time frame. Plans must also collect and report information about whether network providers are actually providing care.
- State regulators should also take enforcement actions against health plans that violate the law, and seek penalties, corrective actions, and restitution to consumers.
- Health plans should be required to meet cultural competence and language access standards. At OAG’s January 2023 mental health hearing, several consumers and advocates testified about the need for culturally competent mental health care. The 2023 amendments to the New York Public Health Law require DOH to consider during its network adequacy reviews an insurer’s ability to provide culturally and linguistically competent care to meet the needs of the enrollee population. These provisions should be codified into a regulatory requirement that all New York health plans provide access to culturally and linguistically competent mental health care.
- Health plans should actively recruit and provide more incentives for mental health care providers to join and stay in their networks, including by providing higher reimbursement rates and reducing administrative burdens on providers.
- The increased demand for mental health services in recent years has exacerbated longstanding network inadequacy, but health plans bear responsibility due to their low reimbursement rates for mental health services compared with physical health care. Health plans should also increase reimbursement rates for mental health providers to incentivize more providers to join their networks.
- Health plans can incentivize greater mental health provider participation in networks by reducing administrative burdens that deter many providers from joining networks. By reducing administrative burdens such as time-consuming and unnecessary prior authorization and documentation requirements, and paying claims promptly, health plans can attract and retain more mental health providers.
Adopting these recommendations can significantly increase access to needed mental health care.
This report is part of Attorney General James’ ongoing efforts to address the mental health care crisis across New York. Attorney General James held two public mental health care hearings in New York City and Buffalo to hear directly from impacted New Yorkers. In October, Attorney General James and a bipartisan coalition of 32 attorneys general filed a federal lawsuit against Meta for harming young people’s mental health and contributing to the youth mental health crisis. Also in October, Attorney General James led a coalition of 18 attorneys general in calling for stronger federal regulations to ensure behavioral health services are covered equally to other types of health care. In August 2021, Attorney General James announced a landmark agreement with United Healthcare to resolve allegations that United unlawfully denied health care coverage for mental health and substance use disorder treatment for thousands of Americans, securing $14.3 million in restitution for consumers.
“I applaud Attorney General James for listening to the needs of New Yorkers and for providing detailed recommendations for addressing our current mental health crisis,” said Tamara Begel, Parent, Co-President of Long Island Families Together and Councilmember of Healthy Minds Healthy Kids, who testified at OAG’s New York City mental health hearing. “Her investigation into provider networks and her subsequent recommendations directly address one of the more detrimental tactics that private insurance companies use to block desperate parents from accessing the help their children need. These obstacles made it so much more difficult for me to find treatment for my son at a time when he urgently needed it.”
“Currently the only path to immediate and guaranteed treatment is a psychiatric emergency room,” said Yerania Simo, impacted individual who testified at OAG’s New York City mental health hearing. “We need to have increased access to doctors and clinics which accept Medicaid and that do not have extended wait lists which stall extremely urgent care and support. I am glad to see Attorney General James doing something to fix this issue.”
“As a parent to a teenage boy going through mental crisis, I cannot express the frustrations and even anger I have felt trying to find providers who could see him in a timely fashion and also accept our health insurance,” said Denise Amato, impacted family member who testified at OAG’s Buffalo mental health hearing. “One year we had to pay out of pocket after our search left us empty and desperate. Their waiting times if they did accept new patients was always two or three months, which when you are dealing with a fragile and manic mind, is unacceptable. Time is of the essence and I thank Attorney General James for addressing this critical issue.”
“At a time when untreated mental health and substance use disorders are creating a public health emergency, it is unconscionable that people desperate for help are turned away,” said John Coppola, Co-CEO, InUnity Alliance. “Reimbursement rates that do not cover the cost of providing services and a lack of adequate state support for financially vulnerable programs have resulted in program closures when expansion of services to meet increasingly severe needs is what is needed. This is an untenable and unsustainable situation that must be addressed to help those suffering unnecessarily. Attorney General James’ attention to this important issue is deeply appreciated by service providers and people needing help across New York state.”
“Every New Yorker should have access to mental health and substance use treatment when they need it and for however long they need it,” said Amy Dorin, Co-CEO, InUnity Alliance. “That’s how we build resilient communities! The data provided in the report is shocking, and the recommendations for greater accountability of the plans are on target. We thank and applaud Attorney General James and her team for their commitment to helping communities access mental health care and prosper.”
“Ensuring all New Yorkers have access to mental health care has always been the leading priority for NAMI-NYS,” said Sharon Horton, Executive Director, National Alliance on Mental Illness-New York State (NAMI-NYS). “We are troubled by the many barriers to care that remain, especially those generated by too many insurance companies that have not facilitated connections to local providers. This report conducted by Attorney General James’ office highlights the unfortunate experience of many vulnerable New Yorkers who are trying to get access to mental health care but are met with roadblocks from health plans. We need health insurance companies to do their part and maintain accurate and up to date directories of available providers to be able to connect New Yorkers with mental health care professionals to help them. NAMI-NYS applauds Attorney General James for listening to the needs of New Yorkers and working to address the mental health crisis.”
“This report illuminates what we have long heard from families: having insurance coverage often does not enable them to access the mental health care they need,” said Kayleigh Zaloga, President & CEO, NYS Coalition for Children’s Behavioral Health. “The NYS Coalition for Children’s Behavioral Health commends Attorney General James on her pursuit of answers and real solutions in this analysis of network adequacy. We appreciate that a third of the secret shopper calls were parents seeking services for their children, highlighting the particularly devastating lack of services available for young people. New York state can and must do better to enforce parity and network adequacy requirements, and health plans must draw more providers into their networks and increase consumer access to care by raising their reimbursement rates. This report makes it clearer than ever that the status quo is simply unacceptable for New York’s children and families.”
If you or someone you know has an issue accessing care because of health insurance issues, please submit any reports online or call OAG’s Health Care toll-free helpline at 1 (800) 428-9071.