President and CEO, Mental Health Association in New Jersey
Mental Health Association of NJ Finds Access to Providers Lacking
Rhonda, a young woman living with both bipolar disorder and an eating disorder for most of her life, was frustrated. She’d been trying for weeks to find a new psychiatrist, after being released from an inpatient clinic, where she was treated for a severe bipolar episode. On a list of 15 providers, several were simply unreachable, either wrong numbers or no answer. When she got through to the others, they were either not accepting her insurance or had a 4-6 week wait for an appointment. She felt distraught and hopeless. She didn’t know how she would cope.
Rhonda’s story is not surprising, considering the results of a recent study conducted by my organization, the Mental Health Association of NJ (MHANJ). The study revealed the challenges faced by insured patients in locating and being seen promptly by a psychiatrist who participates in their health insurance plan’s network (“in-network”). According to Dr. Linda Gochfeld, psychiatrist and member of the MHANJ Public Policy Committee, if a patient does not “…get a positive response after a few tries, they are likely to give up and may continue a downward spiral into hospitalization, disability, or even suicide.” Our study’s findings that health plans’ behavioral health networks are inadequate and or misrepresented were troubling, especially for those in dire need of psychiatric care.
Uncovering the problem
MHANJ operates an information and referral helpline, New Jersey Mental Health Cares (MHC), that attempts to connect callers seeking mental health services with local behavioral health providers. Our MHC staff indicated that an overwhelming number of callers reported an inability to secure appointments with in-network psychiatrists as substantiated by our own efforts to assist. This psychiatry shortage pushed us to study and understand the issues around those who have insurance but can’t find providers.
Though the majority of caller complaints revolved around Medicaid and Medicare, our statewide survey efforts focused on health plans offered by New Jersey commercial insurers (for example, Aetna, AmeriHealth, CIGNA, Coventry, Geisinger, Horizon, and Oxford/Liberty). We chose to study accuracy of psychiatry networks within PPOs, as opposed to HMOs and Medicaid plans, because PPOs typically offer consumers the widest choice as to physician specialists. The study uncovered the following:
- One-third of the psychiatrists listed in network directories had incorrect information, including wrong contact information and providers that were either no longer practicing or were deceased
- Only approximately half of the providers listed were accepting new patients
- One-quarter of patients had to wait two months or more for an appointment
Since publishing our results, we’ve taken and continue to take several important steps to address the psychiatric network inadequacies affecting NJ patients:
- Meet with health plan executives to ensure that they are assessing and regularly updating their mental health provider directories
- Educate consumers as to their legal rights
- NJ law requires health plans to assist consumers in securing necessary treatment from an in-network behavioral health provider that is within 45 miles or a one-hour drive. If no in-network providers are available, patients are entitled an “in-network exception” which allows them to be treated by a non-network provider willing to accept a fair payment provided by the health plan. It became clear through our follow-up that most patients were unaware of their legal rights
- Alert members of our legislature about these issues and identify ways to address the health plan network directory inaccuracies and address the shortage by incentivizing providers to accept insurance
Our advocacy has had results. Assemblywoman Mary Pat Angelini has introduced a bill addressing the issues of workforce parity for psychiatrists vis-à-vis other specialty providers.
Upon approaching the New Jersey Department of Banking and Insurance (DOBI), the organization responsible for ensuring network adequacy, we learned that health consumers were not complaining about the lack of accuracy in the network listings. DOBI did not even know about these issues. Consensus was that HMOs should be questioned annually as to whether providers are still active, whether they need to be taken off the networks, and to inform them that if they want to remain in the networks they have to take new patients.
This is just the beginning, not the end. While our work on the study may be complete, we believe that our ongoing efforts are essential to ensuring that you, our health care consumers, are
- Made aware of state protections that require the health plan to assist you in locating a provider to address your specific diagnosis and treatment needs. You must assert your rights
- Encouraged to report issues of network adequacy and inaccuracy to the health plan, employers, and the state agency responsible for regulating the insurance industry. If the agencies don’t know about a problem, they can’t fix it
- Connected to your local mental health organizations with the appropriate resources in your community for support
This challenge is not limited to New Jersey. A recent study released in Psychiatric Services, a peer-reviewed journal of the American Psychiatric Association, reveals similar findings about network inadequacy and providers not accepting insurance in cities like Boston, Chicago, and Houston. This underscores more than ever that it is imperative that we collaborate both in the public and private sectors to effect change. We are a stronger voice for change if we advocate together.
- What have been the consequences of an unreasonable appointment wait time on your health, or the health of a loved one?
- What has been your experience with finding in-network providers?
- How will you support advocacy efforts that address the inadequate access to in-network providers?
As President of the Mental Health Association in New Jersey (MHANJ), Carolyn Beauchamp has been a leader in the public mental health field for over two decades. A graduate of Gettysburg College, Ms. Beauchamp received her M.S.S.W. from Columbia University School of Social Work and pursued three years of post graduate training in family therapy at the Mid-Jersey Institute for Family Therapy.