More than 30% of New Yorkers suffer or have suffered from some type of health problem mental health, figure that becomes higher among vulnerable groups, according to organizations that ensure mental health, such as NY Health Foundation. And while there are health programs and plans designed to help those who struggle with mental diseases, ranging from anxiety, depression, bipolarity, to schizophrenia and more serious conditions, there are serious problems in accessing support and health services. mental health that make it more difficult how patients and families struggle to live better lives.
This was denounced by the New York Prosecutor, Letitia James, through a new report in which she points out important flaws in access to mental health care through insurance companies, including basic points such as that 86% of insurers’ mental health provider directories are inaccurate, exacerbating the mental health crisis.
The report, which also includes testimonies from New Yorkers with mental health problems collected in two public hearings held by the New York State Attorney’s Office, revealed that after surveying nearly 400 mental health providers included in health plan networks, the vast majority turned out to be “ghosts”, because in reality they did not provide service for everyone, they were not within the network or they did not accept new patients. Patients from marginalized communities feel this impact more disproportionately, worsening their mental health and putting them at higher costs, often impossible to pay.
“No one who communicates with the mental health professionals listed by your insurance company you should be told that the providers are inaccessible, do not accept your insurance, or are not accepting new patients. “Our state is facing a mental health crisis and this report clearly shows that insurance companies are not helping New Yorkers in need,” said the Fiscal James, who called on health plans to improve those failures and join in helping address the mental health care crisis. “By failing to maintain 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.”
During the meetings that the prosecution held with affected communities, one in the Big Apple and another in Buffalo, between June of last year and January 2023, the Office of the Attorney James assured that more than 100 patients and providers described the mental health care system as a system broken, which included parents spending months unsuccessfully trying to find a care provider, not only worsening their children’s conditions but also generating stress and distress in family members.
The prosecution conducted a comprehensive statewide review of 13 health plans: Aetna, CDPHP, Cigna, Emblem, Empire BlueCross BlueShield, Excellus, Fidelis, Healthfirst, Independent Health, MetroPlus, Molina, MVP and UnitedHealthcare, and of 396 providers, only 56, making up 14%, offered appointments, leaving the majority of patients struggling with mental health issues unable to access treatment using their health insurance and many are left to fend for themselves with the only option being to pay out of pocket. , which is not possible for many, and they must give up treatment altogether. Those most affected are low-income people, people of color, people with disabilities and women.
And in order to address the crisis and ensure that New Yorkers with mental health issues have access to the treatment they need, in an affordable manner, the Attorney General’s Office issued a series of recommendations.
First of all, urged state agencies to propose regulations for network adequacy for mental health and substance use disorder treatment services by December 31, 2023.
He also warned that state regulators, such as the Department of Health (DOH), the Office of Mental Health and the Department of Financial Services, must actively and frequently monitor health insurance networks through secret buyer surveys and other techniques to ensure their directories are up to date.
“In particular, health plans should be required to ensure members can get an appointment with a network provider in a short period of time. Plans must also collect and report information about whether network providers actually provide care,” the Attorney General’s Office said. “State regulators should also take enforcement action against health plans that violate the law and seek sanctions, corrective action and restitution to consumers.”
The same way, Prosecutor James’s Office He assured that health plans should be required to meet the standards of cultural competence and language access, since one of the great needs of patients is that there is competent mental health care in their language and taking into account their culture.
“The 2023 amendments to the New York Public Health Law require DOH to consider during its network adequacy reviews an insurer’s ability to provide culturally and linguistically competent care to meet the needs of its enrolled population,” it said. the prosecution. “These provisions should be codified into a regulatory requirement that all New York health plans provide access to culturally and linguistically competent mental health care.”
The Prosecutor’s Office added that health plans should actively recruit and provide more incentives for mental health care providers to join and remain in their networks, including by providing higher reimbursement rates and reducing administrative burdens for providers.
“Increased demand for mental health services in recent years has exacerbated long-standing network inadequacies, but health plans are shouldering the responsibility due to their low reimbursement rates for mental health services compared to physical health care. “Health plans should also increase reimbursement rates for mental health providers to encourage more providers to join their networks,” the state office said, also emphasizing that health plans can encourage greater participation by mental health providers. mental health in networks by reducing the administrative burdens that deter many providers.
“By reducing administrative burdens, such as time-consuming and unnecessary documentation and prior authorization requirements, and paying claims promptly, health plans can attract and retain more mental health providers,” the U.S. Attorney’s Office concluded. NY. “Adoption of these recommendations can significantly increase access to needed mental health care. If you or someone you know is having trouble accessing care due to health insurance issues, please submit any report online or call the Attorney’s Office’s toll-free Health Care helpline at 1 (800) 428-9071.”
Data
- 86% of mental health provider directories are inaccurate
- 13 health plans were reviewed by the Prosecutor’s Office
- 396 suppliers were part of the report
- 56 only offered appointments to patients who were looking for them
- Low-income people, people of color, people with disabilities and women hardest hit
2023-12-07 23:51:10
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