AG James' report finds health insurers 'failing to help New Yorkers' access mental health care [The Buffalo News, N.Y.]

Dec. 7—A report from state Attorney General Letitia James found that health insurance companies across New York fail to maintain accurate network directories of mental health care providers, which is worsening access for patients seeking care and exacerbating the state's behavioral health crisis.

For the report, released Thursday, staff from the attorney general's office reviewed 13 health plans, including insurers in Buffalo, Rochester, Albany and New York City, and then called nearly 400 mental health providers listed on the health plans' networks.

What the attorney general's office found: Of the 396 providers called across all plans, only 56 providers — or 14% of those contacted — offered appointments. The remaining 86% were "ghosts," meaning they were unreachable, not in network or not accepting new patients.

"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 in a statement. "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. I am calling on health plans to rapidly address this problem and help us tackle the mental health care crisis."

Addressing the state's mental health care system has been a major focus for James. The attorney general held a mental health hearing in New York City in June 2022 and another one in Buffalo in January, gathering testimony that her office planned to use to push for legislative and enforcement solutions.

At the Buffalo hearing in January, attended by more than 100 people, most of the more than 20 people who spoke described a broken mental health system. In a statement Thursday, the attorney general's office called particular attention to one story shared during the Buffalo hearing from a parent who testified about her struggle to find appropriate care for her child and how that led to eight to 10 psychiatric emergency room visits.

Following the hearings, and after hearing stories of parents trying and failing to find a provider through their insurance plan, the attorney general's office decided to conduct a statewide review of 13 health plans: Aetna; CDPHP; Cigna; Emblem; Empire BlueCross BlueShield; Excellus; Fidelis; Healthfirst; Independent Health; MetroPlus; Molina; MVP; and UnitedHealthcare. Those 13 plans provide coverage for roughly 12 million New Yorkers.

The attorney general's office did not say why those health plans were chosen, though the report notes calls were made to listed providers in New York City, Albany, Buffalo and Rochester to "ensure geographic diversity." Western New York's largest health plan, Highmark Blue Cross Blue Shield of Western New York, was not included in the report.

In a statement Thursday, the New York Health Plan Association, which represents 26 health plans, said its members "take seriously their obligation to provide comprehensive behavioral health benefits" in compliance with state and federal laws. The association noted that while health plans work to ensure provider directories are as up to date and as accurate as possible, it takes a shared commitment from providers to update their information when there are changes in their network status.

"The challenges facing the behavioral health care system are not unique to New York and have been exacerbated by widespread workforce shortages," association President and CEO Eric Linzer said in a statement. "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."

For its report, the attorney general's office conducted a "simulated patient secret shopper study" to examine the extent of the mental health provider ghost networks in the state. For two-thirds of the calls, staff tried to schedule an appointment for a fictional adult patient, while one-third of the calls involved attempting to schedule an appointment for a fictional 14-year-old patient.

Of the 13 health plans the attorney general's office reviewed, four of them — Fidelis; Independent Health; Molina; and United Healthcare — involved calls placed to Buffalo-area providers.

The attorney general's office placed 20 calls to psychiatrists, psychologists and social workers in Buffalo listed in Independent Health's provider directory. Of those, four providers were in-network and only two offered appointments.

The report also claims Independent Health's provider directory did not specify whether providers were accepting new patients, which is a requirement under New York law. The provider directory from Rochester-based Excellus, which owns Univera Healthcare in Western New York, also did not specify whether providers were accepting new patients, the report noted.

Independent Health spokesperson Frank Sava said the insurer appreciates "the importance of this report and the ability to access care for mental health services, especially for our most vulnerable members."

To help ensure its provider directories are up to date, Sava said Independent Health does an annual survey and employs some of the same practices the attorney general's report used, including secret shoppers. Having accurate directories, he added, also requires providers to update their information when changes occur.

Sava also said ensuring access to mental health providers will require more efforts to address the shortages in the mental health workforce. Recognizing those workforce challenges is among the reasons why Independent Health started offering telemedicine services for behavioral health care through Teladoc in 2019, he said.

"We will closely review the findings in the Attorney General's report and look forward to working together with state agencies to ensure access to behavioral health providers through accurate provider directories and an expanded workforce," Sava said.

Similarly, the attorney general's staff also placed 20 calls each to Buffalo-area providers listed on the networks of Fidelis, Molina and UnitedHealthcare. Four providers on Fidelis' network offered an appointment, while just two did so on UnitedHealthcare's network, and only one offered an appointment on Molina's network.

James' report also offered recommendations for how to increase access to mental health care.

Her office recommends that state regulators monitor health insurance networks through secret shopper surveys and other methods to ensure that the directories are up to date.

Other actions the attorney general would like to see include: state regulators taking enforcement actions against health plans that violate the law; health plans being required to meet cultural competence and language access standards; and health plans recruiting and providing more incentives for mental health care providers to join and stay in their networks, which could include providing higher reimbursement rates.

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