Thursday, October 27, 2005

The Ghost Network

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 and exhausted from this experience, and deciding not to go further with finding a therapist?

Consider yourself 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 [1].

I have been part of a Ghost Network, haunting the managed care company of Group Health Insurance, for almost a decade. I do not participate with them, have signed no contract with them - - 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 discover I am not. I do not participate with *any* managed care companies because I think they are unethical in the way they regulate health care, but that is for another post.

When the person calling discovers that I am not in their network, I always help them try to find a good therapist... and I always educate them about the Ghost Network they have found themselves in. I tell them to inform their employer and colleagues about the situation so that the next time a choice for a different insurance coverage comes up, a change can occur. Managed Care companies sell their services by "showing off" the list of specialists they have in their network. The Managed Care organizations that use a Ghost Network are engaging in fraudulent behavior and bad faith, making promises they cannot deliver. Before my phone call ends, I tell them to call GHI to share their dismay as well. I am not the only ghost haunting GHI or other insurance and managed care organizations. This is a rampant problem in the United States!

The real issue here is the method behind the madness...Insurance companies and managed care companies want you, the person looking for help, to get frustrated. They want you to fatigue and get disgusted in the hopes that you will chuck all your plans for intervention or treatment. Yes, Ghost Networks are about making money.

Ghost and Phantom Networks are very difficult with which to get removed. I have written, faxed and called many, many times over the years, only to learn that I am still haunting and lurking in spirit. There are even deceased practitioners listed in Phantom Networks. I wonder how they sign their yearly contracts?

Ghost Networks are widespread throughout the United States says Dr. Lawrence Lurie, chair of the APA Committee on Managed Care. Dr. Russ Newman agrees and adds,"When a consumer tries to access the promised benefit, he or she finds that many of the health professionals on the provider list are simply 'phantoms' of managed-care marketing and not really available" [2]. The legal issue here is that you are entitled to a specialist for your needs. If there are no specialists because of the Ghost Network practice, your are entitled to have one at no additional cost to you. You can find the specialist if one is not provided for you. Many people do not know this.

The National Coalition of Mental Health Professionals & Consumers wants to know about the experience that you have had with a Ghost or Phantom Network. If you have found yourself unable to access covered mental health or medical services because you can't find a professional in the network they want to know. This grass roots movement is a great resource. You can also contact your State Attorney General to file a complaint should you be unable to find a health care practitioner.

How does finding a therapist or doctor work in other countries...are there obstacles too?

Good services should never be hard to find!

[1] Psychiatric News:
[2] American Psychological Association:
[3] National Coalition of Mental Health Professionals & Consumers

Citizens for the Right To Know:

How to Play HMO Hardball:

National Alliance for the Mentally Ill:

American Board of Examiners in Clinical Social Work:

The American Psychiatric Association:

The American Psychological Association:

The American Counseling Association:

The American Medical Association

The American Mental Health Alliance

The Clinical Social Work Federation:

The National Coalition of Mental Health Professionals and Consumers

The Unites States Senate Site Patient's Bill of Rights:


A Flowered Purse said...

That has happened to me several times.
I can never ever find a good therapist, never. and when i do find someone they aren't covered.
It stinks
Thanks Dr Deborah

the_applicant said...

Yes, it's difficult for me as a Canadian to grasp how managed care can be useful since we have a medicare system. It really puts the client second. Do you find it influences who are able to seek treatment from you? Because the people who choose to see you will have to pay themselves, right?

Dr. Deborah Serani said...

Dear Dianna,
There are ways to find good therapists. I'd be happy to help you find a good one where you live if you like.

Dear Aquarius,
I see some patients for no fee, and some for a modest fee. I think it is so necessary for clinicians to offer cut prices for those whose don't have insurance opportunities. I have a set number of cases a week that I schedule that way. The rest pay me my regular fee. So, I don't make a great living, but I make an honest one. The US desperately needs to improve health coverage. Till then, I'll keep pointing out its flaws!


fsgsf said...

Interesting blog.


NJ from NJ

dawn said...

OMG, almsot everyday i learn something new about your health care system, and everytime it leaves me thinking WTF? This Ghost Network thing is absurd, and sickening.
we have it pretty easy here, in canada, but we must have a referral 1st, from a family doc(GP)before we can see a mental health profesional and for it to be covered by our provincial health care(ohip).

that must be so irritating for you, having your name keep coming up. sorry you have to deal with that constantly.

I n g e r said...

This pisses me off big time--and especially when it comes to mental health professionals, since I can just imagine people giving up on getting treatment.

"I do not participate with any managed care companies because I think they are unethical..."

Another reason to love you.

Rose said...

I have never experienced this before but it is great information to know since it is growing. Crooks and theives are disguised in many ways. It is a shame the practices that folks go to defraud others. Thanks

D.P. said...

I had this happen with Premera Blue Cross . . .I had to change therapists because of this, yet Premera continues to list my original therapist as part of their network. Not only that, but they randomly change the copay almost every time I meet with my therapist--for the same Dx! The copay seems to change depending on the person processing it! Ugh--it is frustrating!

Anna Mason said...

This is very interesting. I didn't know there was something like this out there. I had a hard time finding "qualified" oral surgeons (in my network) close to my home, so I had to go around 2 hours away to have jaw surgery. But i don't know if that is related at all. I might not "get it"....but I voted for your blog on that site. It was a little hard to figure out...but I think I did it right.

Melanie_D said...

Oh yeah - I'm letting them know alright!!! I went through 5 therapists that were listed on my plan to be told by them that they were not under that plan and then the next 2 that were covered had LONG waiting lists. Tough to feel crazy at times.

Thanks for the info Deb.

Shirazi said...

I dont live in USA but many similar things happen to me. BTW, you are much better of despite this. Yes you are.

kath said...


it explains a few things..
thanks for the info.. and the ghost!
( I stole it, and made it into stationary ... BOO! )


Anonymous said...

I want you to know how beneficial your blog has been for me! I have a wonderful therapist and my insurance does cover her. That said, I know tons of people who have similar issues to the one you've related here. What a wonderful gem your words are! Thanks for some honesty about the mental health arena. Brava! Can I take you home and keep you around for future reference??!!! LOL

Anonymous said...

Liz from I Speak of Dreams, commenting. I found your blog from a reference at Shrinkette.

There's another aspect to Ghost Networks: dead doctors. I own a house that was formerly owned by a psychiatrist who retired from practice in 1990; he died in 1995. He is STILL getting mail from provider networks, psychiatric organizations, and so on. I've tried getting him off to no avail.

Thanks for this great post. You have hit it right on the money: Ghost Networks are all about generating income for the managed care companies.

Heidi said...

Wow..very interesting...I wonder if the other side of the border < Canada> has similar issues.

Have a great weekend~

Dr. Deborah Serani said...

Dear NJ,
Hope your holidays were filled with peace. Thanks for stopping by!

Dear Dawn,
I think the Canadian system can teach us a thing or two or three or four..... LOL.

Dear Inger,
I know you are such an advocate for therapy...I am too, that's why I won't let overcontrolling capitalists get in the way!

Dear Rose,
Yup, disguises and frauds lurk in many places. It is a shame.

Dear DP,
That is so weird that the copay keeps changing. It may be built into you insurance plan that each time you have a visit your copay goes up and up and up. Sometimes that happens. See if that is the reason why. If not, please make sure no one is being fraudulent.

Dear Anna,
Insurance companies have a "circle or mileage marker" that delineate your coverage. You can fight to get an oral surgeon closer that 2 hours away, if you want to fight, that is. They should cover you for the services you have received already from this surgeon. If you have trouble, link to some of the sites and they'll walk you through it so you don't have to pay out of pocket.

Dear Mel,
Wow, they are frustrating you...which is the result they want. You can tell them that you will contact the state insurance department and your attorney general if they don't make a "special consideration" for you. You can find a therapist that you like and they HAVE TO pay the therapist directly. That is a "Special Consideration". Like I said in the post, many people don't know that they have this right, and often don't access it. I hope you can find someone soon and not have to pay out of pocket!

Dear Shirazi,
I agree, I am better despite this. I can sleep at night. I feel good about myself... and feel honorable inside and out!

Dear Kath,
Wasn't the ghost cute? So glad he could make you smile too.

Dear Traci,
Oh, thank you for your kind words. I am a shy person, but I like feeling empowered, and like helping others to feel empowered as well. Take me everywhere with you! You are all with me in my heart wherever I go too.

Dear Liz,
LOL...I wonder how these deceased doctors sign their contracts? You must be getting SO much mail. I hope that it can soon end. Junk mail is bad enough, but someone else's Ghost Mail, quite another experience.

Dear Heidi,
Good question! Hope your motherboard is better soon...though you are doing so well without the spacebar! Wishes for a good weekend to you and everyone else.


ellesu said...

My husband is a contract worker -- which means we are on our own as far as insurance is concerned. Which means we can't afford to get sick. ;)

So nice to live in the richest country in the world, huh?

OhioRuthie said...

Unfortunately many will get frustrated and not keep looking for help...they really know how to manipulate the consumer. It keeps the consumer from cutting into their profits by having to actually pay out any benefits...its a shame and I am glad there is a movement to stop it.

Shirazi said...

The way you feel about yourself makes a lot of diference. No?

I am learning to feel that way. Only it is difficult sometime, in given situations in life.

Heidi said...

"though you are doing so well without the spacebar!" Thanx for the early morning laugh..I guess u didn't read my update.I purchased a new keyboard Thurs night. The little things we take for granted eh? ;)

Dr. Deborah Serani said...

Dear Ellsue,
I can feel your frustration. I also have to pay for complete family insurance, being self employed an all, which is a huge, HUGE payment each month. Richest country in many ways, poorest in so many ways.

Dear Ohioruthie,
Your comment is so on target. Grass roots movements can be so powerful in helping to dethrone tryannical control.

Dear Shirazi,
So important to find balance within yourself. I feel "rich" emotionally. I am sure that with all that is going on where you live, it is a challenge to feel rich and hopeful about things.

Dear Heidi,
No, I didn't read your update, but will visit now. How funny!!


Ms. Vickie said...

Imagine my surprise at finding out this and I worked for many years for HMOs. I know they are disliked by many but there is some positive as well as the negative with them. The one I was working for when I made the decision it was time I must go on LTD due Missy (my name my for Multiple Sclerosis)the position I held was responsible for the provider area however the Mental Health was carved out and contracted to a large company which did not even allow us to see the list of providers which I thought was very inappropriate. The Mental Health area was one I always had a problem with in HMO's and still do. Thank you so much for providing this great information.

OhioRuthie said...

To answer your question about how long the graphics take...not long as long as I have the photos on hand...its just placing them that takes the most time...average about an hour I guess. I just finished a simple one for the dogs and put it up today.

Dr. Deborah Serani said...

Dear AlwaysVictoria,
You are right, there are some things MCO's can do well. But overall, their job is to limit care so money can be made. There's something wrong with that ideology. Hope you are doing well with your MS.

Dear Ohioruthie,
Sounds like it gives you a ot of joy to create. I know creating and art does that for me.


Deb S. said...

Very informational. The graphic is a nice touch. Thank you.

Dr. Deborah Serani said...

Thanks! I have learned how to use the graphics so there'll be some in every post.


Cathy said...

What an absolute scam. I hvae never been in such a situation in Canada, so don;t know what our scenario would be here, but have never heard of anything like it. Thanks for spreading the word.

Dr. Deborah Serani said...

You have NO idea.

Another reason Canada rules!!!

east village idiot said...

I LOVE that ghosty graffic you have posted. the rest of the info is sadly not surprising.

chase said...

I don't have health care because I work for myself. I can't get medicade becasue since my daughters father died she gets a modest ssi, and I cant afford to buy insurance.

So in a nutshell, i better not get sick, get a toothache, get depressed, have a baby, or lose any more of my eyesight or im screwed.

The whole government is this bohemoth (sp?) that is set on making money...whether it's thru health care, car insurance, credit scores, insurance, or whatever....they have all turned into hoses just sucking the public dry. I swear this country is eating itself from the inside out.

end rant

Nancy said...

I have never heard of ghost networks, but it does not surprise me in the least. Good for you for exposing them Deb! It is always the mark of a true and caring professional who will help patients find a therapist or doctor, or lawyer even. Too bad there are not more people like you in this world.

We have never used our insurance for psychiatric or psychologist servies, as they don't pay enough and it seems we are just destined to spend $125 or $150 an hour for their services. Although the psychologists spend the hour letting us talk. The psychiatrist usually finds out that things are going fine and keeps the meds the same and spends all of fifteen minutes with us and charges the full $125. But, he is worth every penny!

Thanks for posting this most interesting info. You have a happy Halloween too Deb!

Jessie said...

Hey Deb,

Here in Holland we don't have to work from some list.
Your family doctor has to agree (so your bills are paid by the insurance company) but besides that you can pretty much go to any specialist you want. In most cases the family doctor picks one for you, but you can choose someone else if you like.

A Flowered Purse said...

Wanted to stop in and wish you a Happy Happy Halloween!!

Dr. Deborah Serani said...

Dear EVI,
Everyday I learn more tech stuff to do. It is rather sad that the US healthcare is in such a poor state.

Dear Chase,
It is so terrible to fall in the cracks with qualifying for coverage. What an outrage. I think your rant is so purposeful. Now only if we can get the powers that be to hear us!

Dear Nancy,
Integrity is so important to me. I hate seeing anyone taken advantage of in any situation. Blogging has really helped to get so many of my "issues" out there. LOL.

Dear Jessie,
I'd be very interested to learn how coverage for health gets funded in your country. It is really wonderful that you can find the care you need without obstacles!

Dear Dianna,
"Boo" to you and yours too.
I love Halloween and the fun that it inspires.


Jessie said...

Hey Deb,

Im not really familiar with the full details but Ill let you know what I know.
In some cases, you get the bill at home, you pay it and than send it to your insurance company for restitution. Sometimes you just get the bill and you dont have to pay and in some cases you never see a bill at all.. getting in touch with a specialist is exactly how i told you: you go to your family doctor, and he/she gives you "permission" to find a specialist. sometimes the doctor contacts, for instance the hospital, and there they assign you someone. Sometimes the doctor tells you to go find a specialist, like a psychologist, yourself, he/she can recommend someone.
not everything is always paid for by the insurancecompany.. psychologists usually have a 25% you have to pay for yourself. most of that stuff depends on your insurance.
and thats about all the rules i know. there are no further limits (except for you family doctor.. you have to be a maximum of 20 minutes away..)
i found a site on the history of the dutch healthcare system. (ive inserted it as my webpage ;))
hope you enjoy!

ow just realized, we do have at least one major obstacle: waitinglists... really big problem here.. right now an increasing number of people are looking for medical care outside the nation. countries like switserland are very populair and some insurancecompanies started covering those expenses.

Dr. Deborah Serani said...

Hey Jessie,
Thanks so much for answering my question. Your system sounds very much like ours, except for the referral process. There are long waiting times here as well. Healthcare is so hard to find sometimes WHEREVER you live I guess.

Hope you are having a great day!