Mental health ‘ghosts’ haunt many New Yorkers seeking help

New York Attorney General Letitia James released on Thursday a comprehensive report that clearly demonstrates health insurance companies doing business in New York are often failing to offer adequate access to mental health care.

James says the situation is exacerbating the mental health crisis in New York — and the case she lays out certainly seems to affirm her assertion.

The Office of the Attorney General surveyed nearly 400 mental health providers listed on health plans’ networks and found that the overwhelming majority, 86%, were “ghosts,” meaning they were unreachable, notin-network, or not accepting new patients.

These inaccurate network directories, the attorney general says, are worsening the statewide mental health crisis, leading to adverse health outcomes, and increasing costs for patients.

“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 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.”

James is calling on these health plans to rapidly address the problem.

As part of its research, staff at the Office of the Attorney General 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% of those contacted, offered appointments. The other 86% of the listed, in-network mental health providers staff called were unreachable, not in-network, or not accepting new patients or “ghosts” as the report calls them.

The situation, James said, leaves a vast majority of residents across New York 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 the poor, the disabled and people of color.

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 sixmonth wait lists over three years.

“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.”

“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 and CEO of the 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.”

As part of her report, James lists an array of recommendations for state agencies and officials as well as health insurance providers to address the issue. While we certainly don’t profess to be experts in the field of health insurance, many of the Office of the Attorney General’s recommendations seem practical and common sense — and we would urge regulators and insurers to work together quickly to address this situation which impacts so many.

If you or someone you know has an issue accessing care because of health insurance issues, call the OAG’S Health Care toll-free helpline at 1-800-428-9071.