Tuesday, December 15, 2009

Tips for Dealing With Ghost Networks

If you live in the United States, has this ever happened to you?

You call a psychologist, social worker of psychiatrist who is on your plan only to find out that they are not on your plan?

Have you found yourself feeling disgusted from this experience?

Have you thrown the towel in, forgoing the therapy route?

If so, you need to consider that you are being haunted...by a Ghost Network.

A Ghost Network, also called a Phantom Network, is a collective list of doctors and specialists that your insurer insists are contracted providers for your medical or mental health needs. However, many of these identified individuals are not members of the network.

I have been part of a Ghost Network, haunting the managed care company of Group Health Insurance, for over a decade. I do not participate with them, haven't signed a contract - yet, year after year, they have my name in their panel of specialists. Many potential patients call my office thinking that I am in their plan, only to learn the ghostly, uh, I mean ghastly truth, that I am not.

If you find yourself bedeviled by a Ghost Network, try these tips:

1) Tell your employer and colleagues about the situation so that the next time a choice for a different insurance coverage comes up, a change can occur.

2) Managed Care companies and Health Insurance Carriers sell their services by "showing off" the list of specialists they have in their network. Ask your employer or Human Resources Department to cold-call doctors to see if their provider list is accurate.

3) The Managed Care organizations that use Ghost Networks are engaging in fraudulent behavior and bad faith, making promises they cannot deliver. Call your state Attorney General and Insurance Department and lodge a complaint. Never underestimate the power of your voice.

4) The legal issue here is that you are entitled to a specialist for your medical needs. If there are no specialists because of the Ghost Network practice, your are entitled to have one at no additional cost to you. Many people don't know this!


McCain-Edwards-Kennedy Patient Bill of Rights

13 Things Your Health Insurer Doesn't Want You To Know

This is New York State's Managed Care Complaint Website For your own state, do an online search.


Wanda's Wings said...

It's scary what insurance companies can do.

Dr. Deb said...

Yup. It is. I both love and loathe them. Terrible to be so pendulum-like.

OHN said...

I too have a love/hate relationship with them.

I hate that they are so powerful.

I love that we had to pay very little for my husband's $125,000 surgery last year.

(Of course, we had to have a surgeon in the network ;)

talesofacrazypsychmajor said...

The problem that I usually has is that a ton of providers will be listed but when I call them I'll discover that either they are not taking new patients or that in some way I don't match the demographics of the types of patients they see (wrong age, wrong diagnosis etc). And of course it takes time to get a phone call back. It's easy to spend weeks playing phone tag with many providers only to find none can help.

Casdok said...

My sons first group home promised many different therapist. Which was one of the reasons i sent him there. They did not exist.
We did not leave quietly!

phd in yogurtry said...

One time a patient came in with a list of psychiatrists. Wanted my input. The list had about ten docs on it. Together we figured out the list actually had two options.

Three of the names were the same doc. Same office, same doc. Several were no longer accepting outpatient patients (worked strictly in psych. hospital). And then there were the docs who seemed to have disappeared into thin air.

This is the state of our mental health insurance. The ever dwindling doctor list. Very frustrating, for both patient and psychologist alike.

Thanks for posting these helpful hints, Dr. Deb.

Kahless said...

That is a disgusting practice!
Absolutely scandalous.

Shattered said...

Insurance co's are SO frustrating. I have dealt with this multiple times looking for various specialists. The last time, I was finally so frustrated that I called my insurance co back, told them that none of the "doctors" accepted their insurance and then somewhat politely asked them to find someone for me. After 30 minutes I not only had a real Dr. but also had an appointment with the Dr. that the insurance co personally set up for me. When all else fails I guess it's time to ask for their help... with fingers crossed. ;)

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Heidi said...

Awful...Just Awful!

Will Meek PhD said...

Great post. I think the other part that is terrifying is that there are some networks where I don't know if I am on them or not, and no one can seem to tell me. Terrible!