Ravi didn’t know it, but he, like millions of Americans, was trapped in a “ghost network.” As some of those people have discovered, the providers listed in an insurer’s network have either retired or died. Many other providers have stopped accepting insurance — often because the companies made it excessively difficult for them to do so. Some just aren’t taking new patients. Insurers are often slow to remove them from directories, if they do so at all. It adds up to a bait and switch by insurance companies that leads customers to believe there are more options for care than actually exist.
Ambetter’s parent company, Centene, has been accused numerous times of presiding over ghost networks. One of the 25 largest corporations in America, Centene brings in more revenue than Disney, FedEx or PepsiCo, but it is less known because its hundreds of subsidiaries use different names. In addition to insuring the largest number of marketplace customers, it’s the biggest player in Medicaid managed care and a giant in Medicare Advantage, insurance for seniors that’s offered by private companies instead of the federal government.
ProPublica reached out to Centene and the subsidiary that oversaw Ravi’s plan more than two dozen times and sent them both a detailed list of questions. None of their media representatives responded.
This happened to us when we wanted to get my son help for some behavioral issues. Trying to find a counselor who specialized in helping children was a nightmare.
Our health insurer’s website listed a few dozen, which was encouraging at first. But when I started calling them most were no longer in business, no longer accepted our health insurance (despite still being listed on the insurer’s website), or didn’t accept any new patients. And of the few who did have some availability, their evangelical Christianity beliefs were a fundamental part of their work - to the point where Jesus preaching was going to be a constant focus of the therapy.
We finally found someone (she was a devout Christian but it didn’t interfere with her counseling strategies, so that’s fine). But even she stopped accepting new patients soon after we signed up because she was so slammed with demand.
The state of mental healthcare in America is fucking atrocious. There are too few therapists in general, especially ones who help children. And as this article points out, health insurers deliberately make it so difficult for those counselors to use them that they refuse to work with with many insurance plans. And so many therapists are outside the pricing of families, even when they have insurance, and even with those therapists giving discounts.
A big part of this is the legacy that mental healthcare still isn’t seen as a legitimate practice by many in the corporate world, despite their false marketing claims. Considering how frequently big insurers screw people out of claims for physical illnesses (cancer, etc.), you just know they will screw people with mental health challenges at least as much. Because to some of them - especially older boomers who are still lingering in senior management rules - it’s all fud.
Another part of the problem (which relates to my previous point) is that mental healthcare isn’t as quantifiable as most physical healthcare (because the brain and feelings are very complicated), so corners are cut and the industry is seen with suspicion and frustration by insurers who are focused on making as much money from their customers as possible.
The net result? A ton of people who are struggling through daily life with their own challenges, and exhausted family members and friends who are having to try to help them as best they can.
Until we massively overhaul the broken healthcare/insurance system here, shit like these ghost networks and the underlying causes and their other effects will continue to break our society.
My two pennys are betting that this is all part of some larger purposeful plot to destroy the US from within, starting with the 1981 Omnibus Budget Reconciliation Act by the Reagan administration which cut federal funding for mental health services and shifted responsibility to individual states who did not have the resources or systems in place to adequately care for those with mental illness.
Or, maybe I’m just paranoid and in need of some help.
It started with Kaiser lobbying Nixon* out of m4a, Reagan just kind of loosened the brake line and put a few bricks on the accelerater.
*I love autocorrect
It’s a feature, not a bug. Meaning it’s designed for profit, not for care.
What the fuck? Those aren’t counselors, those are fucking quacks who should be in prison for fraud!
Providers are suffering, too. Were need single payer comprehensive, and giving the average taxpayer some of the benefits of their tax dollars is easily achievable. We just keep moving economically right.
We got super lucky that a new therapy office that took our insurance opened up here a couple of months after my daughter’s former therapist had to give up her job for health reasons. She really needs therapy to help her stay centered and she was losing it. We were looking into driving her to other towns if necessary. You’re right, it’s a nightmare.