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!


Resources:


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.

Ten Tips to Keep "You" in Yuletide Cheer

The holiday season can be a time of great joy, connection and celebration. And if you find yourself feeling the warmth of the season, you are lucky.

Many, though, do not find the holidays a time for celebration. Family strife, financial woes, traumatic memories and even loneliness can make the season dark, not bright.

If you are having a rough time as the holidays approach, here are some tips to keep YOU in this Yuletide Season.

1. Put yourself first.

2. Don't over-schedule your time.

3. Keep a limit on spending.

4. Avoid triggers that set old traumas into motion.

5. Focus on what you can control.

6. Choose to do things you want to do, not have to do.

7. Keep expectations realistic.

8. Don't be afraid to delegate or ask for what you need.

9. Stay in the present and look toward the future.

10. Use your senses to find beauty and peace in small moments around you.

Season of Cheer or Season of Fear?

"With the holidays season upon us, people everywhere are beginning to prepare for parties, get-togethers and gatherings with neighbors, families and friends.

Such occasions are generally festive, but for the millions of Americans who suffer from anxiety disorders, the "season of cheer" can be the "season of fear."

One form of anxiety is called social phobia, or social anxiety disorder. As with many psychological conditions, the diagnosis is made when feelings and symptoms that are normal in everyone become amplified to the extent that they affect one's daily life.

The condition commonly starts during the teen years and, for some, may persist for many years or even a lifetime. It can be a major source of stress. Although the cause is not completely understood, there seems to be both a genetic predisposition as well as an environmental component. Social phobia sometimes runs in families, but no one knows for certain why some people experience it and others don't.

Social anxiety disorder can be treated with counseling and/or medications. Some of the medicines that are used to treat problems such as depression also are helpful for social phobia, including antidepressants, anti-anxiety medicines and beta blockers. Your health professional can determine which course of action is best for you."

Source:
Mitchell, T. (2009, November 15). Do you have social phobia? USA Weekend Magazine Weekend Magazine