Behavioral Health Network Sued

A mental health care provider network named Carelon that works with the health insurance plan for New York State employees was hit with a federal lawsuit on Monday over claims it misled patients looking for in-network care with lists of providers who didn’t exist, didn't accept the insurance or were otherwise unreachable. We will have a follow up on this story as it progresses.

The story highlights the challenges of getting appointments and underscores why the use of out of network, higher cost mental health care persists.

When people can’t get appointments for medical care or have to wait months, a majority say they just agree to wait, but with mental health they often do not feel able to wait and end up seeking a higher cost out of network specialist. Case in point, 71 out of 100 families we polled report that they’ve tried to get appointments for mental health based on their insurance plan’s directory, only to find that the mental health services are “all booked up” or “not taking new patients” as the website indicated, creating a kind of “shadow network” that leaves these families scrambling, usually having to default to higher cost out of network psychologists or psychiatrists. “Telehealth is okay, but when you need something more advanced, more specialized, that’s when the problem happens,” mom Colleen Ford said about her frustration in trying to help her 17 year old. Ford said they ended up with a “good psychologist” but at $350 a session. “Alternative was 3 month wait to get in.” Several insurers over the years have faced lawsuits for these ghost networks - but they are also challenged if the mental health provider’s won’t agree to a contract or aren’t fully transparent about their schedules or slots. It’s an imperfect system. “We try to monitor and keep these updated but it’s difficult,” a spokesman for a regional health insurer said.

Stay tuned.