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.
