“Ghost” and “phantom networks” describe directories maintained by managed care organizations, listing healthcare providers who are unavailable for their members. However, these networks often include providers who never provided care – or no longer do so – for the plan’s members. Louisiana’s “Ghost” and “Phantom” networks have got to go.
Managed care organizations (MCOs) are also called “Medicaid management companies.” These companies are responsible for creating healthcare and mental health provider networks to serve their members. They publish directories that list all the providers in their network. However, members, providers, and auditors have discovered that many providers listed in these directories are unavailable to serve the members.
Ghost Networks Are Bad for Children and Families
The reasons for Ghost and Phantom networks vary and are all bad for patients. Many of the listed “phantom” providers might not be accepting new patients, severely limit the number of Medicaid patients they see due to low payment rates, no longer participate in the insurance plan, may have moved or retired, or may have been included in a directory without their knowledge. As a result, patients can find it challenging to access care, even though it appears on paper that numerous providers are available.
The dangers of these fictitious networks are that they can lead to delays in care as patients try to find an available provider, and patients grow frustrated or lose trust in their insurance company or managed care organization. Compounding the harm to patients, there may also be additional financial costs if patients who cannot find a provider in their network seek out-of-network care at higher out-of-pocket costs.
Ghost networks raise legitimate concerns about the transparency and integrity of managed care organizations. Patients deserve accurate, up-to-date provider directories. Many states have legislation that requires accuracy, but without enforcement, the legislation does not benefit citizens.
Who are you going to call? Finance hopes not ghost networks: Senate committee study finds that 80 percent of listed mental health providers in directories are unreachable, not accepting new patients or not in-network By Sandhya Raman – May 4, 2023 – Roll Call
Patients seeking mental health treatment for themselves or their families too often find their insurers’ provider directories riddled with inaccurate information, filled with names of providers who aren’t accepting new patients or packed with contact information for providers who aren’t actually accepting that form of insurance.
Also, Understanding Mental Health ‘Ghost’ Networks provides links to public testimony submitted to the Senate Finance Committee.
“Laws were passed in California, Louisiana and Maryland requiring accurate directories, but the problems continued despite the legislation. The researcher studying these efforts concluded that the lack of progress was directly related to weak enforcement mechanisms, minimal penalties, and the lack of critical tools to improve compliance.” (Mary Giliberti, JD Chief Public Policy Officer Mental Health America Before The United States Senate Finance Committee Hearing: “Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks” on May 3, 2023)
Why are Ghost Networks harmful to Louisiana’s children?
- Ghost Networks Delay Care: When parents believe they have a range of options for mental health providers but then discover that many of those options are unavailable, this can result in significant delays in getting care. Delayed care can worsen mental health outcomes.
- Ghost Networks Increase Costs: If parents cannot find a provider in the network, they may be forced to go out-of-network, which usually results in higher out-of-pocket costs. This financial strain can further exacerbate family stress or result in receiving fewer services than are needed.
- Ghost Networks Increase Frustration and Hopelessness: Continually reaching out to providers who are not available can be disheartening for parents whose children need help. Not having promised help creates a sense of hopelessness and reinforces the idea that the healthcare system is too difficult to navigate. Unfortunately, repeated frustration causes some to give up on seeking care.
- Ghost Networks Interrupt Care: If a child’s mental health provider leaves the network (and is still listed), families might be unaware and suddenly find themselves without covered services during a critical period. Also, when children who have been in out-of-home care like a psychiatric hospital return to communities without services, the gains made in intensive treatment can be lost.
- Ghost Networks Reduce Trust: Ghost networks can reduce trust in managed care organizations. If families believe they’re being misled about available resources, they may question the integrity of the entire healthcare system.
Ghost Networks Misallocate Resources: If decision-makers in Baton Rouge believe that adequate networks exist because of inflated provider numbers, they have no reason to prioritize the allocation of resources to expand and improve network adequacy. This could lead to perpetual shortages of mental health providers.
- Ghost Networks Strain Available Providers: The few providers who are accepting patients may become overwhelmed with requests, leading to long wait times and potentially reduced quality of care due to high caseloads.
- Ghost Networks Worsen Health Outcomes: Untreated or partially treated mental health challenges in children lead to worsening symptoms. This can have cascading effect on children and families, including academic struggles, social challenges, and increased risk of substance abuse or other maladaptive behaviors.
- Ghost Networks Create Equity Concerns: Ghost networks tend to exacerbate disparities in access to care, especially if certain regions or populations are disproportionately affected by inaccuracies in listed providers.
Of course, not taking the necessary steps to keep accurate network records is a sign of poor business practices. It suggests that either intentionally, through lack of care, or the inability to perform, an insurance company is failing in an essential duty to its members: ensuring that here are enough providers to meet the needs of its members.
Ghost networks are bad for all the parties involved.
Advocacy groups, legislators, and regulators all over the country are collaborating to find solutions that will guarantee managed care organizations maintain accurate and current provider directories. This is crucial in order to prevent the problems caused by ghost networks. The difficulties presented by ghost networks emphasize the necessity for Louisiana’s healthcare system to be transparent and accountable. This is especially critical for vulnerable populations, such as children who require mental health services.
Louisiana’s “Ghost” and “Phantom” networks have got to go.