Alliance Note: Despite efforts to create parity between Medicaid and commercial insurance coverage from the Governor, Legislature, and state agencies, NYS commercial insurance plans continue to fail New Yorkers by having inadequate networks of providers and low reimbursement rates for required services, leaving people who are seeking support with few to no available options and unfairly high costs. A recent investigation by the NY Attorney General’s office found 86% of mental health service providers listed in the state’s commercial health plan directories were either not accepting new appointments or did not actually accept the individual’s insurance. This leaves many under commercial insurance without available providers or extremely long waitlists, preventing them from proactively accessing desired services.
The commercial network inadequacy also creates a secondary problem due to the low reimbursement rates when providers do accept the insurance. Commercial insurance providers consistently pay far lower rates than Medicaid for the same services, which puts providers of services at a disadvantage because it prevents them from adequately paying the workforce. Providers are forced to decide whether to pay workers less, hire fewer workers, or not provide service to people with commercial insurance. This greatly contributes to the poor accessibility of services by pushing people to leave the workforce for better paying jobs, reducing the number of available providers to support people, and forcing many with commercial insurance to either pay high costs out of pocket or simply not seek services.
New York must continue to address parity issues to increase the availability of services. Enhancing the ability to enforce parity laws is critical to guaranteeing commercial insurance companies consistently cover needed mental health services, reimburse providers at adequate rates, and have robust, up to date provider networks with affordable services. We are thankful for leadership of Lauri Cole and the New York State Council for Community Behavioral Healthcare’s work highlighting this serious issue within our system and their efforts to strengthen parity enforcement. Read below to learn more about the report on the high percentage of “Ghost” providers in commercial insurance networks, including comments from Lauri Cole.
AG Says Health Plans Full of ‘Ghost’ Mental Health Providers, Offering Minimal Access to Care
By Amanda D’Ambrosio Crain’s Health Pulse December 8, 2023
Among mental health providers listed in New York health plan directories, 86% did not take in-network patients — exposing sparse access to mental health and substance use services across the state, a new report shows.
Attorney General Letitia James’ office released a report yesterday showing that only 14% of health plans’ listed behavioral health clinicians accepted appointments for in-network services. The rest were “ghosts,” meaning that they were either out-of-network, unable to take new patients or unreachable entirely.
The results come from a survey of 13 health plans across New York state, including Aetna, Cigna, UnitedHealthcare and Empire BlueCross BlueShield.
“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,” James said in a statement. “I am calling on health plans to rapidly address this problem and help us tackle the mental health care crisis.”
One in five adults in New York lives with a mental illness, according to the report. But despite a high need for care, access remains patchy. Last year, 29% of New Yorkers with anxiety or depression reported an unmet need for counseling or therapy. There are even fewer services for youth.
The attorney general held hearings to further investigate mental health care access in New York state, and testimony from more than 100 patients and providers revealed a “broken system,” the office said. Parents reported months of searching for psychiatrists to provide care to their children and providers called attention to low reimbursement rates that have forced them to stop accepting certain commercial insurance plans.
Health plans in New York are required by law to keep up-to-date provider directories, including information about whether or not a provider is accepting new patients. Law also requires insurers to make sure that their network of providers is robust enough to meet demands for care.
The attorney general’s office conducted a secret shopper survey to explore whether health plan directories offered patients reliable access to mental health care. Researchers called nearly 400 providers, including psychiatrists, psychologists, nurse practitioners, licensed mental health counselors and social workers, all of which were listed in health plan directories as accepting new patients.
Across all health plans, just 56 providers offered an appointment, the researchers found. The percentage of ghost providers varied across health plans. Cigna had the lowest rate of ghost providers at 35%. All of the provider listings in MVP’s network were ghost providers, the report found.
Eric Linzer, president and chief executive of the New York Health Plan Association, which represents insurers across the state, said that “health plans are acutely aware of the behavioral health crisis that both children and adults are facing,” as well as the chronic shortage of mental health workers.
“The challenge here is that the delivery system is currently having real challenges to meet behavioral health demands,” Linzer told Crain’s. “The focus should be on ways to increase the number of available providers,” and not placing the responsibility on just one segment of the health care system, he added.
But behavioral health providers say poor access is driven by more than just a shortage of available providers—it’s linked to inadequate rates paid by commercial insurers for behavioral health services.
Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, said that commercial insurance often pays providers a fraction of what Medicaid pays for behavioral health care because the state dictates Medicaid rates. The result is that some providers have to cut back on the number of patients with commercial insurance they accept or hire fewer providers to keep their doors open.
“If New York is wondering why we continue to have an abundance of overdose in our communities, or why children are sitting in emergency departments not being able to find community-based care upon discharge, this is one of the primary reasons,” Cole said.
The attorney general recommended that state regulators conduct frequent audits of health plan directories, mandate wait time standards to ensure timely access to care and upscale enforcement for health plans that violate directory requirements. The findings come as the state prepares to propose new regulations around network adequacy — which aim to ensure that health plans can provide enough services to meet demand. The Department of Financial Services, Department of Health, Office of Mental Health and the Office of Addiction Services and Supports are required to propose new network adequacy regulations for mental health and substance use services by the end of this year.