Ghost Networks
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MLK Day - A Good Day To Advocate
“Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman,” Dr. King said.
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Ghost Networks
Thank you to Jessica Cravens (Chop Wood, Carry Water) who sent this to me.
Let’s remember how commercial medical insurers make money. They sign up as many policy holders as possible, negotiate low reimbursement rates with doctors and other providers, they deny claims and pre-authorizations based on their own “clinical” experience instead of medical necessity.
Its a long list of activities designed to bring money in and hold onto it as long as possible while it is invested. It has come to light, that insurers do not always maintain an accurate list of in-network providers in your area. The list may include doctors and other providers long out of business or inaccurate contact information or specialties that are just not offered. Maintaining inaccurate “bulked up” lists lets policy holders think they may have in network access to a particular doctor or specialty when it just isn’t so. Having alleged long lists of specialists also let’s them deny requests to increase reimbursement rates to specialists.
So you think you’re buying coverage and you will be able to go to a doctor/provider in network and they are not available. WOW - sounds like FRAUD. You were sold the policy based on the accuracy of the network list and the providers you counted on don’t exist.
How big a problem is it?
Well, Senator Ron Wyden (OR) decided to investigate last year. Here is what he found.
The Senate Committee on Finance staff reviewed directories from 12 different plans in a total of 6 states, calling 10 systematically selected providers from each plan, for a total of 120 calls. Of the total 120 provider listings contacted by phone, 33% were inaccurate, non-working numbers, or un-returned calls. Staff could only make appointments 18% of the time. The full report can be found here.
A recent Lever report investigated United Healthcare’s Ghost Networks in the Boulder, Colorado area. The reason for the investigation was that one physical therapist working with them had not had her reimbursement rate increased in 25 years and asked for a raise. She was told there are too many physical therapists in her neighborhood and so no increase in reimbursement.
Turns out it was all a lie from United Healthcare. She was pretty much the only one in her area. They make little effort to ensure that their stated networks are valid luring unsuspecting customers into the trap of having a robust network from which to choose and all to often finding it was all bait and switch.
As an aside, a friend of mine was a medical provider and told me how insurance companies would lower reimbursements in the middle of the contract year. “Market Forces” Just more BS.
Ok - If you have a health insurance policy that requires renewal, it behooves to to check that the practitioners you think you want are in network - take the time and make phone calls.
I want you to note that none of this would happen with universal healthcare.
ACTIONS
Let’s ask our Member of Congress and Senators to fix this.
Here is a sample text that you can send with RESISTBOT by texting SIGN PGCOXI to 50409.
“I am your constituent and we all deserve a health care system that works for all of us. I just learned that health insurance companies often maintain inaccurate listings of in-network providers. There are so many errors that these are called Ghost Networks. We the consumers are lured into purchasing their health insurance with the goal of having access to those providers. It is a disaster when they are not available. Senator Ron Wyden and the staff of the Senate Finance Committee conducted a study recently that found systematically checking the directories of 12 insurance providers in 6 states they were only able to make appointments 18% of the time because 1/3 of the providers were unavailable due to inaccuracies and unresponsiveness.
Look, this kind of thing is out of bounds with universal healthcare, but we need help now. I want you to build legislation that demands that health insurance companies maintain accurate lists of in-network providers and has penalties if they don’t. Perhaps you could start with a letter to Javier Becerra, the secretary of HHS and Chiquita Brooks - LaSure, Head of CMS, to find out what they can do to address the problem for plans over which the federal government has oversight. Thank you.”
Extra Credit Action
Here is a link to contact information for the Insurance Commissioner in every state.
Let’s call the commissioner where we live and ask them to implement an in-network accuracy rule for health insurance policies sold in our state to eliminate Ghost Networks. Otherwise we are just lambs led to slaughter.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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