Guest post by Joe Hoft at JoeHoft.com – republished with permission
Is “Ghost Networks” Lawsuit Against Insurance Companies the Failure of Mental Health Parity?
It is of interest that a class action lawsuit has been filed in New York which alleges that insurance companies are deliberately harming patients because the directories of listed physicians and professionals are non-existent, a proverbial “ghost network.” The suit further alleges that “there is a mental health crisis in this country and in this state” and the provider directory, the “ghost network,” is “exacerbating patients’ mental health problems” because they can’t contact providers for services needed.
While there are many issues that AbleChild could address about this lawsuit, two problems come to mind. First, whether there is a “mental health crisis,” and who is responsible, is up for debate and, secondly, it seems to AbleChild that this lawsuit is simply an end-around to obtain increased pay for mental health providers, which is being addressed in many states’ Medicaid oversight boards and commissions.
First, the suit alleges that the insurance companies have “mislead” patients by “publishing grossly inaccurate directories of doctors and therapists.” The suit further alleges that these “grossly inaccurate directories” list doctors and qualified professionals who are not within the insurance network – “Ghost Networks.” These “Ghost Networks” “that are replete with errors and duplications, which make them inaccurate, incomplete, deceptive, and misleading” are more likely to be found in Mental Health provider directories.
Minnesota Senator Tina Smith has raised concerns that insurers “are not following the letter and the spirit of the mental health parity law,” which requires insurance companies to cover mental health comparable to physical health. The Mental Health Parity and Addiction Equity Act of 2008 has been controversial from its inception. Why? Because diagnosis of mental health disorders is not based on science or medicine. Mental Health diagnoses are completely subjective, based on the verbal answers provided by patient to physician. There are no biological tests, blood, urine, or brain scans that reveal an abnormality that is any alleged mental disorder.
AbleChild does not suggest that people don’t suffer from serious behavioral and emotional issues. What is fact, though, is that depending on answers provided, a patient could walk away with a different mental health diagnosis from different physicians, hence making “parity” with physical conditions (objective, confirmable abnormalities) difficult. There is no way to medically confirm a mental disorder diagnosis but, for example, a broken leg is easily confirmed through x-ray or cancer through biopsy.
The suit provides background information about the nation’s “mental health crisis” explaining that “an estimated 57.8 million adults or 22.8%” have a mental illness and “younger adults report a higher prevalence of mental health problems.” AbleChild would argue that the “mental health crisis” will never end. By virtue of the subjective nature of psychiatric diagnosing, the mental health industry is driven by money and will continue to increase. The data is clear. Once in the mental health system, always in the system. No one is getting better and the “mental health crisis” is all the proof needed. If the mental health “treatment” was effective, one would expect the numbers of sick to decrease. As is well established, the numbers of mentally sick increase every year and, hence, the “crisis.” Naturally this “crisis” can go on for only so long before everyone is diagnosed with some mental illness and then it is no longer a “crisis” but the norm and, given the yearly increases, that time is not far away. It’s an industry. Big business.
But what is really driving the mental health crisis? One can look at all the power the States mental health commissions/committees hold in influencing legislation across the Nation. For example, in New York the Behavioral Health Service Advisory Council Equity & Regulations Joint Committees met last February and discussed the state’s ability to laser focus on gathering important patient information through surveys. One has to wonder, though, if surveys are utilized in States to collect mental health data, when will a survey be conducted to reveal how many state Medicaid patients are on cocktails of psychiatric drugs and how many patients may have died yearly from mental health treatments?
Two of the members of the Regulations Joint Committee went so far as to suggest removing “medical necessity” from the legislative language and expanding, without limitation, the time allowed through Medicaid for hospitalization services.
(see link of Joint Committees above tape section: 1:12:48 on- length and medical necessity chat)
In Connecticut, its Behavioral Health Oversight Partnership Council discussed earlier in the year whether the state’s providers were underpaid for mental health services. AbleChild questioned the requested increased compensation given the increasing number of patients in the State’s Medicaid program on dangerous mind altering psychiatric drugs. How helpful are these providers if no one is getting better?
It is interesting that the Guardian Newspaper reported this class action lawsuit and quoted Jacob Gardener, an attorney with Walden Macht Haran & Williams LLP, the law firm that filed the suit explaining “a lot of people have encountered that kind of issue and they’re not talking about it because mental health care is not something people are willing to talk about.”
This statement could not be more misleading and inaccurate. Mental Health is one of the most widely discussed and funded of all health specialties. The Biden Administration’s Safer Communities Act, provides increased funding for school-based mental health care and hundreds of millions of dollars have been appropriated to states that will infiltrate schools with mental health “experts.”
If there is a mental health “crisis” now, just wait until the experts get the chance to “provide services” to the children in America’s schools. There will be much talk about the mental health “crisis” then and the State Behavioral Health Oversight Committees will be ready to step in with more “help.”
There is little doubt that insurance companies will be fined and further regulated to ensure that mental health providers are made available. And increased payments for mental health providers through state Medicaid programs, which AbleChild suspects plays a large role behind the scenes in this litigation, will be approved by State Mental Health Oversight Committees. The “crisis” continues, and money continues to flow into the ever-bloated mental health industry.
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