Mental Health Update

The Office of Attorney General Tish James came out with a blistering report in regard to a lack of response from Managed Care Plans  to mental health services   We have a youth mental health crisis in New York and across the country and when someone is at their most vulnerable is when family members or individuals reach out to get support, resources and appointments. Instead, in many cases, they get no or a limited response.   We have had Timothy’s Law (Behavioral Health Parity) on the books for almost twenty years yet people still fall through the ‘parity’ cracks.

The plans need to be made accountable.  We know that all plans are different and some are more responsive than others but the bottom line is that no one in crisis should have to deal with ‘ghost’ providers or unreachable numbers. That is unacceptable.

Governor Hochul has been incredibly responsive to issue around insurance parity but now is the time for greater enforcement of parity laws and simultaneously making plans more accountable for providing immediate services.  We hope to see language in the State of the State calling for greater enforcement of mental health parity.

I am on Spectrum News tonight talking about the report.

https://ag.ny.gov/sites/default/files/reports/mental-health-report_0.pdf

N.Y. insurers’ mental health networks stacked with ‘ghost’ providers, survey shows

MVP, CDPHP plans among those where most providers are unreachable or not accepting new patients, according to new report by the New York attorney general’s office.

By Rachel Silberstein Dec 7, 2023

New York State Attorney General Letitia James’s office released a report Wednesday that finds many insurers in the state have mental health providers listed that don’t pick up the phone, are the wrong number or are not taking new patients.

Spencer Platt/Getty Images

ALBANY — Most mental health providers listed by New York insurance plans are “ghost” listings, meaning they are inaccurate or inaccessible — and Capital Region-based health plans are some of the worst offenders, according to a new report.

Attorney General Letitia James’ office surveyed provider listings of 13 plans — including local insurance companies CDPHP and MVP Health Care — and found that 86 percent of mental health providers were either unreachable, not in-network or not accepting new patients.

The report, which follows a series of hearings on mental health conducted by James’ office in New York City and Buffalo, confirms parent and provider testimony that health insurance companies are failing to provide adequate mental health coverage amid a worsening mental health crisis, according to 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,” James said. “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.”

To evaluate the accuracy of insurance-listed mental health resources, James’ office conducted “secret shopper” surveys, where callers reached out to at least 20 providers per plan in four cities (New York, Albany, Buffalo and Rochester) and attempted to make an appointment. Half of the attempted appointments were on behalf of adult patients and the other half were for children.

Of the 396 providers called across all plans, only 56 providers, or 14 percent of those contacted, offered appointments and just 8 percent of the providers surveyed offered in-person appointments, according to the report.

In Albany, surveyors called mental health counselors, psychiatrists, doctorate-level psychiatrists and social workers that were listed as participating with Fidelis, United Health Care, MVP and CDPHP. The listings indicated that each provider was accepting new patients.

MVP ranked worst of all surveyed plans when it came to the accuracy of its mental health offerings. All 24 Albany providers in the plan’s network that were surveyed were classified as “ghosts.”

Seven MVP providers did not work at the location reached by the listed phone number, and seven were not accepting new patients. Two providers called for a child appointment only accepted patients with developmental disabilities, but this limitation was not indicated in their listings. The rest of the numbers were non-working or providers did not return the call.

CDPHP listings were similarly outdated; 92 percent of the 26 Albany mental health providers surveyed were unreachable or not accepting new patients. Just two Albany practitioners were available. One accepted adults and the other saw children, but only provided medication management, not psychotherapy.

“This is problematic because, although medication can be an important part of mental health treatment, it is sometimes overused and many children with mental health diagnoses need psychotherapy,” the study’s authors wrote.

CDPHP is the most common health plan in the Capital Region, with approximately 330,000 members in its commercial and Medicaid plans. The Schenectady-based MVP has about 440,000 members in its commercial insurance and Medicaid plans statewide.

Medicaid managed care programs like Fidelis and UnitedHealthcare, which mainly serve low-income and unemployed residents, varied greatly in the accuracy of their listings. About 95 percent of Albany mental health providers in the Fidelis network were ghost listings, while about 65 percent of calls made to UnitedHealthcare listings did not result in an appointment.

New York and federal law requires health plans maintain accurate mental health directories. Ghost networks also suggest violations of laws requiring health plans to maintain adequate provider networks and cover mental health treatment at the same level as physical health.

James held mental health hearings in New York City and Buffalo in June 2022 and January 2023 to solicit feedback about the growing mental health crisis that was exacerbated by the COVID-19 pandemic.

In both hearings, more than 100 patients and providers described a broken system. Providers described persistently low reimbursement rates, which made it difficult to participate with many insurance plans. Parents testified they spent months trying to find a provider through their insurance plan but could not find one, which led to their children experiencing worsened conditions.

“As a parent to a teenage boy going through mental crisis, I cannot express the frustrations and even anger I have felt trying to find providers who could see him in a timely fashion and also accept our health insurance,” parent Denise Amato said in Buffalo. “One year we had to pay out of pocket after our search left us empty and desperate. Their waiting times, if they did accept new patients, was always two or three months, which when you are dealing with a fragile and manic mind, is unacceptable.”

The report noted the pressure placed on hospital emergency rooms, where youth in crisis often wind up staying for days or months because there is no safe place to discharge them to. In written testimony for the Buffalo hearing, Albany Medical Center Hospital reported that the number of children coming to the hospital with suicidal ideation had more than doubled in three years.

The report highlights a failure of state regulators, such as the Department of Health, the Office of Mental Health, and the Department of Financial Service, to monitor insurance providers’ practices and take enforcement action. Insurance companies must also adequately reimburse providers, according to the report’s recommendations.

The analysis follows other efforts by the attorney general’s office to tackle mental health, including James’ participation in a coalition of 32 attorneys general that in October filed a federal lawsuit against Meta for harming young people’s mental health. Also in October, James led a coalition of 18 attorneys general in calling for stronger federal regulations to ensure behavioral health services are covered equally to other types of health care.