Health insurers not providing adequate mental health coverage, attorney general says
State Attorney General Letitia James addresses the media outside New York State Supreme Court in Manhattan on Nov. 8. Credit: AP/Yuki Iwamura
ALBANY — State Attorney General Letitia James said Thursday that 13 of the state’s major health insurance companies failed to provide adequate mental health services sought by her staffers who posed as customers in a statewide survey.
The survey contacted nearly 400 mental health providers listed on the companies’ network directories for its customers. The report found 86% of calls to the providers seeking mental health services were not successful in getting care, James said. Those providers contacted were unreachable, not in the network despite being included on a company’s directory, or were not accepting new patients.
Just 56 of the 396 providers — 14% — that were called across all plans would accept appointments, James stated.
“The study confirms widespread violations of directory accuracy laws and suggests an alarming absence of in-network providers of mental health services,” the report states. “This gap in care will lead to adverse health outcomes and higher financial costs to patients, especially those in marginalized groups. Inaccurate directories also distort health insurance markets and undermine health insurance regulation.”
The report focused on the health insurance companies, which are responsible for providing the care through mental health providers in a company’s network. The report stated that several providers listed in a company’s directory had told the company repeatedly that they are not in the company’s network, yet remained on the list for customers to contact.
When New Yorkers can’t get mental health care in their health insurance company’s network, they are often forced to hire a provider outside the network at a higher cost, if they can afford it, the report said.
James said the report “clearly shows that insurance companies are failing to help New Yorkers in need … I am calling on health plans to rapidly address this problem and help us tackle the mental health care crisis.”
The companies surveyed were Cigna, United Health Care, Empire Blue Cross Blue Shield, AENTA, Excellus, MetroPlus Health, Fidelis, Independent Health, Molina, Capital District Physicians' Health Plan, HealthFirst, Emblem Health, and MVP. Other than CDHP, the companies didn't immediately respond to requests for comment Thursday or referred Newsday to the New York Health Plan Association.
The New York Health Plan Association stated that the health insurance companies it represents take the obligation to provide for mental health coverage and parity for health care seriously.
“The challenges facing the behavioral health care system are not unique to New York and have been exacerbated by widespread workforce shortages,” said Eric Linzer, president and CEO of the association. “Our industry remains committed to working with the attorney general, the Hochul administration, and legislative leaders on policy solutions to increase access and ensure patients can get the mental health care services, care, and support they need.”
Allessandra Skinner, of Capital District Physicians' Health Plan based in Albany, said part of the concern is that some providers don’t inform the health insurance company that they are no longer accepting patients. She said her company also has a 24-hour hotline for members to be connected to mental health providers who are accepting patients, as well as virtual health care that has helped connect members to care faster. She said the company will also work with the state.
“We’ve seen a surge in the demand for mental health services particularly since the pandemic and there are staffing issues,” Skinner said in an interview. “We have worked very hard to expand access to these services.”
The attorney general’s office is taking no action against the companies for their “ghost networks,” but indicated it may take action if reforms are not made.
“Ghost networks are illegal,” the report states. “New York and federal laws require that health plans maintain accurate provider directories. Ghost networks also suggest violations of laws requiring health plans to maintain adequate provider networks and cover mental health treatment the same way as physical health,” which is legally described as mental health parity.
The report recommends the State Legislature and state regulating agencies “vigorously enforce the law and impose consequences for violations, including monetary penalties.”
The report recommends that companies:
- Conduct regular audits of their provider networks.
- Make sure directories are accurate and that mental health care has parity with physical health care. The results should be sent to regulators and posted on a public website.
- Reduce waiting time for patients to get appointments.
- Consider “a centralized provider director for all health plans” that could reduce costs.
- Recruit more providers, especially professionals from racial minorities.
- Make it easier to file complaints. The report found that only 3% of patients made complaints to the state, 9% percent filled out their company’s complaint form, and 16% called their companies to complain.
“Only a multifaceted approach can effectively address the unmet need for mental health treatment in New York,” the report states. Health insurance companies “are obligated under New York and federal law to ensure access. By doing so, they can improve the lives of millions of New Yorkers.”
The report said the mental health crisis in New York is extensive: 3 million adults — one in five — live with mental illness and 31% of New Yorkers reported symptoms of anxiety or depression in a February survey by the Kaiser Family Foundation. The foundation also found that more than half of insured adults who don’t get care said they lacked coverage through their health plan.
The attorney general’s office conducted its study through a “secret shopper” method in which callers simulated the experience of consumers, the report stated. Staffers posed as family members seeking mental health care for a relative including children.
Michael Gormley has worked for Newsday since 2013, covering state government, politics and issues. He has covered Albany since 2001.
