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11:20 am
Tue November 19, 2013

The Magic Pill, Part 4: Is Anybody Out There?

Originally published on Thu February 6, 2014 3:16 pm

This story is the fourth installment in a five-part series on mental health care. Click here for the entire series.

Insurance Networks don't always  provide accurate - and adequate - networks.   At what point is a network that doesn't provide sufficient numbers of providers and information crossing the line? 


In 2007, the Maryland Psychological Association set out to see if what they’d been hearing was true: insurance companies were listing providers who weren’t available.   They tried to contact more than 900 mental health professionals from all over the state who were listed by private insurance networks. They found almost half of the info on the provider panels was inaccurate, says Paul Berman, the spokesman for the psychological association.  "Forty four percent was inaccurate.  Even though the managed care companies said these were verified – they were inaccurate and it was impossible to get a hold of them".  

They’re called “ghost rolls” – the providers have moved, retired or died, or maybe they aren’t accepting new patients.  

Berman says they took the report to state lawmakers and others and got nowhere,  "the feedback was “no surprise” – the legislators were well aware.    Then, not much happened".

Lawmakers told him managed care companies said their lists were accurate.   And therein lies the problem, says Adrienne Ellis, an advocate with The Mental Health Association of Maryland.   ''In Maryland, the insurance companies determine whether or not their networks are adequate," Ellis says. The Maryland Insurance Administration monitors insurance companies to be sure they list enough providers, but whether those providers are working anymore?  That’s up to the insurance company. "We’ve heard that providers ask to be removed from the directory or they are no longer taking new patients – but they stay on the directories so it APPEARS they are taking more patients than they are," she says.     

That's not the case, says Pam Greenberg is with the ABHW, Association of Behavioral Health and Wellness.  The group represents companies that insure 2.5 million Marylanders.  She says they’re not doing the old “bait and switch”.   She says they send out postcards to providers to update our information, but the rub is: when a provider moves and they send out a postcard, it doesn’t reach them.  Greenberg concedes there may be some inaccuracies, but says the real problem is the shortage of mental health professionals.

So now, six years after the report and with health reform on the table, state Health Secretary Joshua Sharfstein, says he won’t let this issue slide.  Sharfstein, who also chairs the board of the Maryland Health Exchange, which oversees private insurance plans on the exchange, says there’s network accuracy and network adequacy.  Accuracy deals with addresses, phone numbers, whether doctors are seeing new patients or not.  He says the exchange has created a website to track accuracy.  Adequacy is more complicated , says, "I think what we're going to look at in the state, not just in the exchange, is can patients adequately find doctors?  Reporter: So, if a patient has to wait two months? Sharfstein: That’s inadequate!   No, I don't think that's adequate."  

He says the exchange will use consumer complaints to help track networks and determine whether they are adequate.  

Ellis – from the Mental Health Association of Maryland – says they’ll help people who aren’t able to find in-network mental health provider file complaints.

But she says, it’s a tough plan to follow through on., it’s not easy to get someone with a mental health problem to bring complaints.  

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