BOSTON – On Thursday, the Massachusetts State Senate unanimously voted to support An Act to increase consumer transparency about insurance provider networks, legislation filed by Senator Jason Lewis to eliminate “ghost networks” among Massachusetts health insurers and increase access to mental health care for patients who need it.
Out-of-date and inaccurate health insurance provider directories appear to have a large number of in-network providers. In reality, the number is often much smaller, as providers may have moved, closed their practices, no longer accept new patients, or no longer participate in particular health insurance plans. These “ghost networks” are especially challenging for people seeking care for behavioral health conditions: in 2018, the Division of Insurance reported provider directories for behavioral health services listed only 29% to 64% completely accurate information.
“Many families and individuals seeking health care, particularly mental health care, are unable to find a provider that meets their needs because of outdated and unclear provider directories,” said Senator Jason Lewis, the lead sponsor of the legislation. “Accurate provider directories are critical to improving access to timely and appropriate care to reduce disparities, to improve health outcomes, and to decrease unnecessary utilization of emergency room and inpatient care. I’m very pleased that the Senate took this important step forward.”
For many families and individuals, provider directories are the “front door” to accessing services for behavioral health conditions. Struggling through outdated information and refusals by multiple unavailable providers is exhausting and frightening, leaving patients at risk for clinical deterioration and harm, often ending up with a visit to the emergency room, rather than getting appropriate care when it was needed.
The legislation passed in the Senate passed ensures that consumers have the best information available to meet their health needs. An Act to increase consumer transparency about insurance provider networks would require insurers’ provider directories include the most up-to-date list of participating doctors and specialists and their services. The bill also creates a task force to study and recommend further improvements to provider directories, particularly information about behavioral health providers and the specific services they offer. This legislation was the result of months of collaboration between the Senate, insurers, providers and other stakeholders.
The legislation now awaits action in the House of Representatives before it can be considered by the Governor to become law.