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!
Footnotes
[1] Psychiatric News:
http://www.psych.org/pnews/00-11-03/its.html
[2] American Psychological Association:
http://www.apa.org/monitor/feb02/phantoms.html
[3] National Coalition of Mental Health Professionals & Consumers
http://www.nomanagedcare.org/article.html
References
Citizens for the Right To Know:
http://www.rtk.org/grievance.htm
How to Play HMO Hardball:
http://www.hmohardball.com
National Alliance for the Mentally Ill:
http://www.nami.org
American Board of Examiners in Clinical Social Work:
http://www.abecsw.org
The American Psychiatric Association:
http://www.psych.org/
The American Psychological Association:
http://www.apa.org
The American Counseling Association:
http://www.counseling.org
The American Medical Association
http://www.ama-assn.org/
The American Mental Health Alliance
http://www.americanmentalhealth.com/
The Clinical Social Work Federation:
http://www.cswf.org
The National Coalition of Mental Health Professionals and Consumers
http://www.thenationalcoalition.org/
The Unites States Senate Site Patient's Bill of Rights:
http://www.senate.gov/~dcp/patients_rights
