NEW YORK—Health insurance companies are failing to offer adequate access to mental health care, says a report released on December 7 by NYS Attorney General Letitia James.

Her office surveyed nearly 400 mental health providers listed on health plans’ networks and found that 86 percent were “ghosts,” meaning they were unreachable, not-in-network, or not accepting new patients. 

James said inaccurate network directories are worsening the state’s mental health crisis and affects marginalized communities disproportionately. State agencies must propose regulations by December 31 to insure that mental health and substance use disorder treatments are available to every insured New Yorker.

A broken system

At mental health hearings, more than 100 patients and providers described a broken system. A Black parent from Rochester testified about her struggle to find care for her child in a tangled and deeply inequitable system, James said when releasing the report. The parent and child endured eight to 10 psychiatric emergency room visits, more than 15 mental hygiene arrests, and countless referrals, meetings, and six-month wait lists over three years.

“No one who reaches out to mental health professionals listed by their insurance company should be told that the providers are unreachable, not accepting their insurance, or not accepting new patients,” said James. “Our state is facing a mental health crisis, and this report clearly shows that insurance companies are failing to help New Yorkers in need. 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 forgo the care they need.”

Parents told James’s office that they spent months unsuccessfully trying to find providers through their insurance plans all while their children’s conditions worsened.

13 health plans fall short

Following the hearings, the attorney general’s office conducted a statewide review of 13 health plans: Aetna, CDPHP, Cigna, Emblem, Empire BlueCross BlueShield, Excellus, Fidelis, Healthfirst, Independent Health, MetroPlus, Molina, MVP, and UnitedHealthcare. Callers attempted to schedule an appointment for an adult or child with a mental health provider who was listed as accepting new patients. Of the 396 providers called across all plans, only 56 providers, or 14 percent of those contacted, offered appointments. Eighty-six percent of the listed, in-network mental health providers called were ghosts.

New Yorkers rely on health plan provider directories to access health care services. But when the providers are ghosts, sufferers have to choose between paying out-of-pocket or forgoing treatment altogether.

A woman provided testimony that after treatment for depression in the emergency room, she was told that she would be referred to a therapist in a clinic that would accept Medicaid. However, she could not access treatment with any of the providers to whom she was referred, since they either did not return her calls or had long waiting lists. A mother testified that she was unable to obtain in-network treatment for her elementary school-age child, who suffers from attention deficit hyperactivity disorder.

Sharon Horton, executive director of the National Alliance on Mental Illness-New York State, said the organization is troubled by the many barriers to mental health care that persist. “We need health insurance companies to do their part and maintain accurate and up to date directories of available providers to be able to connect New Yorkers with mental health care professionals to help them.”

Recommendations

James’s office has made the following recommendations to address the problem:

• State regulators, such as the Department of Health, the Office of Mental Health, and the Department of Financial Services, should regularly monitor health insurance networks through secret shopper surveys and other techniques to ensure their directories are up to date and that members can get an appointment with an in-network provider within a short time frame.
• State regulators should take enforcement action against health plans that violate the law, and seek penalties, corrective actions, and restitution to consumers.
• Health plans should meet cultural competence and language access standards.
• Health plans should recruit mental health care providers and provide more incentives for them to join and stay in their networks. Health plans have low reimbursement rates for mental health providers compared with physical health care providers.
• Health plans should incentivize greater mental health provider participation by reducing administrative burdens, such as time-consuming prior authorizations and documentation requirements, and paying claims promptly.

In October, James and a bipartisan coalition of 32 attorneys general filed a federal lawsuit against Meta for harming young people’s mental health and contributing to the youth mental health crisis. 

In 2021, a landmark agreement with United Healthcare resolved allegations that United unlawfully denied health care coverage for mental health and substance use disorder treatment for thousands of Americans, securing $14.3 million in restitution for consumers.

The attorney general’s health care toll-free helpline at 1-800-428-9071.