Lawsuit accuses Anthem Blue Cross Blue Shield of New York of harboring a 'ghost network'
To the surprise of many patients, most of the doctors in this network don't accept their insurance plan, lawsuit alleges.
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A new lawsuit filed in the Southern District of New York accuses Anthem Blue Cross Blue Shield of New York of maintaining a "ghost network" of doctors, with patients pursuing pricey out-of-network care and experiencing care delays due to inaccurate provider directories.
To the surprise of many patients, most of the doctors in this network don't accept their insurance plan, the lawsuit alleges. Patients sought mental healthcare but were confronted with false options and struggled to find an in-network provider.
WHAT'S THE IMPACT
The law firms representing the plaintiffs completed a secret shopper survey in which they called the first 100 doctors on Anthem's directory.
Only seven out of the 100 actually accepted the insurance and would take new patients. The rest either did not accept the insurance, were not mental health providers, did not accept new patients or were unreachable, according to a release from law firm Pollock Chen, one of the firms representing the plaintiffs.
The lawsuit states that there were 4,300 providers listed on a downloadable directory of psychiatrists, but many of those listings were duplicates with different phone numbers and addresses.
"We knew ghost networks were a problem, but we had no idea it was this bad," said Steve Cohen of Pollock Cohen. "Both the New York State Attorney General and the United States Senate have conducted similar secret shopper studies. But neither investigation was as extensive as the one we conducted on behalf of these plaintiffs. And the findings were just shocking – it is nearly impossible to find doctors who accept this insurance."
According to the firm, ghost networks cause significant financial harm to patients because going out of network for their care incurs substantial expenses, as well as delays in finding essential care. Often, patients abandon seeking care because they can't find in-network doctors who accept their insurance, the firm said.
Anthem Blue Cross Blue Shield has not yet replied to a request for comment.
THE LARGER TREND
A Deloitte analysis published in May found mental health inequities may not only harm individuals but also hinder economic prosperity, and could total about $478 billion in avoidable costs throughout the rest of this year.
Left unchecked, the numbers suggest this could balloon to up to $1.3 trillion by 2040. That's equivalent to about $42,000 per person living in the U.S.
Last month, the departments of Labor, Health and Human Services and the Treasury issued final rules meant to clarify protections and expand equitable access to mental health and substance use disorder benefits.
The rules are intended to achieve the promise of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, federal agencies said. The act requires group health plans and health insurance issuers offering group and individual coverage that offer mental health or substance use disorder benefits to cover those benefits in parity with medical and surgical benefits – without imposing greater restrictions on mental health or substance use disorder benefits as compared to medical and surgical benefits.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
