American Health Policy Institute

Senate Mental Health Network Adequacy Hearing – Could Employer Plans Be Next?

A Senate Finance Committee hearing on inaccurate mental health provider directories and network access problems in Medicare and Medicaid suggests employer plans could be the next to face criticism from Capitol Hill.

Provider directory errors. Senate Finance Committee Chair Ron Wyden (D-OR) released a “secret shopper” report which found 33% of mental health provider listings were inaccurate, had non-working numbers, or the provider did not return calls. The survey evaluated 12 Medicare Advantage plans across six states and 120 mental health providers were contacted.

More than 80% of the listed, in-network, mental health providers were considered “ghosts” as they were either unreachable, not accepting new patients, or not in-network. The report found significant variation, by plan and state, with appointment availability rates ranging from 0% in Oregon to 50% in Colorado.

While the current focus of the report was on Medicare Advantage, other reports have found similar problems with employer plan provider directories and appointment access. In the hearing, committee members made it clear they plan to incorporate changes similar to those contemplated for Medicare and Medicaid plans to the commercial market, when possible. Sen. Wyden described ghost networks as a “breach of contract for insurance companies to sell their plans for thousands of dollars each month while their product is unusable” and that he will “use all resources at my disposal as Chairman of the Senate Finance Committee to get some real accountability.”

Outlook: Last year, Sen. Wyden introduced “ghost network” legislation to increase reporting accuracy, strengthen enforcement, and create civil monetary penalties for employer health plans found out of compliance. HR Policy has been working with congressional staff to address our members’ concerns with the bill before it is reintroduced this year.

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Authors: D. Mark Wilson



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