maxblau.bsky.social
Atlanta-based investigative reporter with ProPublica's South team, covering health care, public health, and the environment. Get in touch at [email protected].
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We’re still looking to hear from mental health providers, health insurance insiders and patients. Do you have a tip for us? Please fill out this form. www.propublica.org/getinvolved/...
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My colleagues and I are continuing to report on the ways insurers meddle with mental health care. We’ve looked at why providers have left insurance networks and the patchwork of mental health protections across the country. www.propublica.org/series/ameri...
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If you find yourself caught in a ghost network — and can’t find a mental health provider that accepts your insurance — here are the key steps that experts suggest for you to consider. www.propublica.org/article/how-...
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The harms from ghost networks are real. I recently reported on how Ravi Coutinho, a 36-year-old entrepreneur from Arizona, died after running into problems with his plan’s ghost network. Here’s that story: www.propublica.org/article/ambe...
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The group has stated that errors could be corrected faster if the providers did a better job updating their listings. But providers have told us that’s bogus: They’re not always removed from the directories when they formally drop out of a network.
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Insurers acknowledge that errors happen. The industry’s top trade group has said that insurers contact providers to verify that their listings are accurate.
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Dr. Robert Trestman, a leading American Psychiatric Association expert on ghost networks, said state agencies have failed to enforce regulations. “They’re not doing their job. If they were, we would not have an ongoing problem.”
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Even when penalties for directory errors do happen, they are small and sporadic. In an average year, there are fewer than one-dozen fines issued by regulators. All those fines represent a fraction of 1% of the billions of dollars in profits made by the largest insurers.
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Spokespeople for the state agencies told ProPublica that their “many actions” resulted in “significant accountability.” But ProPublica found that the actual actions taken so far do not match the regulators’ rhetoric.
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In each of those states, insurance regulators can’t point to a single penalty for ghost networks.
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Massachusetts’ attorney general investigated alleged efforts by insurers to restrict their customers’ mental health benefits. The insurers agreed to audit their provider listings but were largely allowed to police themselves.
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Arizona regulators also called hundreds of mental health providers. They couldn’t schedule visits with nearly two out of every five providers they called.
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Staffers with the New York attorney general’s office called 396 mental health providers to schedule an appointment. Eighty-six percent were “unreachable, not in-network, or not accepting new patients.”
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States have passed laws intended to protect customers from “ghost networks,” where health plans list providers who supposedly accept that insurance but who are not actually available to patients. But those efforts are only as good as their enforcers.