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Insurers undermining mental health access, report claims

Finding a mental health provider and paying for treatment is supposed to be just as simple as securing any other type of medical care, under both state and federal law. But that’s not always the case, according to a new report from the Mental Health Association of Maryland.

Insurance companies’ provider directories frequently contain inaccurate or out-of-date information about psychiatrists, which makes it difficult for patients to find a doctor, the MHAMD report found.

To compile the report, researchers analyzed private health plans sold on the state’s health exchange, Maryland Health Connection, because those are the only plans whose provider network directories are public.

Less than half of all psychiatrists listed as in-network were even reachable, the report found. Of those who were reachable, only a fraction both accepted the insurance and were taking new patients.

In all, of the 1,154 psychiatrists listed as in-network for the four insurance carriers on the exchange, only 14 percent actually accepted insurance and had an available appointment within 45 days.

“What this report shows is a serious lack of transparency on behalf on the insurance companies,” said Adrienne Ellis, a director at MHAMD.

The smallest carrier on the exchange, however, was an outlier in the report. Nearly 80 percent of listed psychiatrists for that carrier had open appointments within 45 days and still accepted insurance.

The carriers were not identified by name in the report — each was assigned a letter — but Evergreen Health Cooperative is by far the smallest insurer on the exchange.

A spokesman for CareFirst BlueCross BlueShield, the state’s dominant carrier by far, said in response to requests for comment that the company regularly works to update the directories.

“We work on many fronts to keep contact information up-to-date for psychiatrists and all other health care providers in our networks,” CareFirst spokesman Scott Graham wrote in an email. “Files with updated provider directories are shared with [the health exchange] every two weeks.”

Representatives from the two other insurance carriers (United Healthcare and Kaiser Permanente) did not immediately respond to requests for comment Monday.

Carolyn Quattrocki, executive director of the Maryland Health Benefit Exchange, said the exchange “continues to focus on how to improve network adequacy standards for plans offered through Maryland Health Connection.”

“The Chesapeake Regional Information System for our Patients (CRISP), which compiles the provider directory on our behalf, has also recently developed at our request a mechanism for providers to make corrections in the directory,” Quattrocki said in an emailed statement.

“We will now work with carriers and the Maryland Insurance Administration on the best way to use that mechanism to update CRISP, carrier and MIA records,” she said.

But at one psychiatry practice, according to the MHAMD report, the appointment manager told researchers who called seeking an appointment that “that doctor hasn’t worked here in eight or nine years. We told the insurance company that years ago, but we can’t get him removed.”

Ellis said that was a common response throughout the study period. She also said it’s “distressing” that such a small percentage of listed psychiatrists are available to see patients in a timely fashion.

“If you’re wealthy and can pay out of pocket for an out-of-network provider, you should be OK,” she said. “But if you’re trying to use your health insurance, you’re going to have problems.”

Being able to use health insurance for mental health treatment is the whole point of what are called “parity laws.”

Under federal and state law, access to behavioral health care can’t be more restrictive than access to regular medical care, said Ellis, who leads The Parity Project at MHAMD. For example, an insurance company cannot charge a higher copay for behavioral health services than the consumer’s usual copay for medical services.

Though the report only includes data for insurance plans sold on the exchange, many consumers with plans sold by the same carriers off the exchange experience similar problems, Ellis said.

But, she said, the lack of reliable information for exchange plans is particularly troubling.

All plans sold on the exchange must cover the same core set of health benefits, so consumers are making their choices primarily based on the cost of the plan and whether they are satisfied with its provider network.

“People are browsing plans on the exchange and choosing one based on the information they see posted about it,” Ellis said. “That’s the point of having the search function for the provider networks.”

With out-of-date network information, consumers aren’t making fully informed decisions, she added.

About Alissa Gulin

Alissa Gulin covers health care, education and general business at The Daily Record.