Many of us have been there. When you get a long list of providers from your health plan, you’ll find that many of them lead to dead ends. Some don’t accept new patients or don’t actually participate in your insurance company’s network. Some lack the necessary expertise.
ProPublica reporter Max Blau recently wrote about how the bait-and-switch scheme known as the Ghost Network ended in tragedy for a 36-year-old man in crisis. his story, ‘I don’t want to die’: In need of mental health care, he gets trapped in the insurance company’s ghost networkRabbi Coutinho detailed his unsuccessful search for addiction treatment in Arizona.
Blau followed Advice to consumers People struggling to find mental health care providers and professionals A column about his reporting process and reader reactions..
Ghost networks may be contributing to lack of access to mental health care, and federal and state policymakers are responding by: Consider strengthening regulations. However, the term ghost network is relatively new. In an interview, Blau explained what journalists need to know.
The following interview has been edited for brevity and clarity.
Where did the term “ghost network” come from?
Over the past decade, it has appeared in academic journal articles as an easy-to-understand way to explain provider directory errors. Network accuracy indicates whether the provider information provided to you as a consumer is factually accurate. There is another term: network adequacy. This refers to whether there are enough providers in a geographic area to serve all people enrolled in health insurance.
What’s the difference between a ghost network and regular inaccuracy?
If the phone number is wrong, the address is wrong, or you need someone with an opioid use disorder and you can’t tell from the directory if that person is an addiction psychologist, regulators can remove those ghosts and ghost providers. I will consider it. Essentially, any false or misleading information that prevents a consumer from making a reservation is covered.
It seems like a ghost network masks network inadequacies.
absolutely. In many states, insurance companies tend to submit provider directories as part of the compliance process. In some states, you sign a document certifying that you are complying with the law, but regulators don’t actually check it. Neither customers nor regulators have any idea how many providers are actually available.
Do ghost networks only apply to mental health, or is it just one area of particular concern?
That’s one particularly problematic area. These actually apply to all areas, including the medical and surgical aspects of insurance, and mental health.
Do we know how widespread this problem is?
No, even most states don’t have a clear sense. Much of what we know comes from a growing number of secret shopper surveys about certain types of insurance. For example, last year the Senate Finance Committee did the following: Ghost Network Research on Medicare Advantage Plans. Some focus on geographic areas, such as commercial planning in some cities.
How do ghost networks impact patient care?
Experts have studied this and found that policyholders are more likely to face higher out-of-pocket costs and delays in treatment if they receive treatment. The story I wrote about Rabbi Coutinho is a case study of the worst that can happen if you don’t get the care you need. The potential for harm is generally recognized not only by regulators, legislators, and advocates, but also by patients who experience it firsthand.
Some states have laws regulating the accuracy of provider directories. Why are these laws so difficult to enforce?
The executive departments of state agencies tend to be understaffed. In some states, it is unclear how companies are actually held responsible for complying with the specifics of the law. And some insurance commissioners are concerned that enforcing the law too punitively or aggressively could force certain insurance companies out of the market and reduce options for consumers. I think it came from the insurance commissioner. You have an agency tasked with bringing insurance companies to market, as well as regulating them and ensuring compliance.
Do you have any advice for journalists who want to cover ghost networks?
Understanding how the government regulates insurance is an important first step. If you’re looking at a specific state, ask, “How does that state handle insurance issues?” It may be helpful to obtain documentation from state insurance agents, as they issue reports on the work they perform. No matter where you are, there are likely to be consumer advocacy groups that specialize in these issues, and these groups can be very helpful in explaining how insurance affects mental health care. got it.
