NYT Article re: Insurers and NYS Council Reaction

April 7, 2024

Good morning,

I just posted the following commentary on my LinkedIn page.  I use the page to post on behalf of our association.  Please follow this page:  https://www.linkedin.com/feed/update/urn:li:activity:7182699096447578112/

The link to the NY Times article I refer to (below) is here:  https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html?unlocked_article_code=1.ik0.tffq.DL1gXdqLpETL&smid=url-share

(LinkedIn Post), 4/7/24)Across the country and here in NY, the amount of substance use and mental health care that is provided ‘out of network’ is significantly higher than it is for physical health care. State leaders have known this for a long time and it was confirmed by Milliman in 2019. Here’s the Report: https://lnkd.in/eJbU2wJj

Today the NY Times published an important article looking at the conflicts of interest and other ways insurers and third party vendors work together to increase profits and in doing so, burden the care recipient who (in too many instances) will walk away from getting the care they need due to excessive and unexpected cost share responsibilities (co-pays, high deductibles, etc.).

Staying in-network can be especially difficult for community-based mental health and substance abuse treatment agencies due to inadequate rates paid to providers here in NY. The NYS Council has been leading the fight to ensure ALL reimbursement rates paid to community-based providers approximate the actual cost of care for a long time. We need laws, regulations and contract terms that require insurers to play it straight and deliver on the promises they make to their beneficiaries without the game playing and use of tactics that are clearly designed to discourage beneficiaries from USING their insurance. And we need regulators to bear down on insurers – to robustly surveil, monitor and enforce ALL laws, regulations and contract provisions. Bad actors must be called out and heavily fined the first time there is a citation issued against an insurer rather than waiting months and sometimes years to enforce the law.

(From the NYT article) “A California woman whose teenage son was battling opioid addiction found only one treatment center that would accept him, and it was out of network. “When your kid has hit rock bottom, they’re dying, you get them in wherever you can,” she said, speaking on the condition that she not be named to protect her son’s privacy.

They had the most expensive health plan her employer offered, but her insurer, citing MultiPlan, left the family with tens of thousands of dollars in bills. “I expected there would be some payment that wasn’t covered,” she said. “What I didn’t expect was the deceit that caused an even higher payment, an amount I never dreamed.”

Is this the insurance system we want and need? To be clear, the current youth mental health crisis, unrelenting overdose rates, increased rates of alcohol abuse and long waiting lists for mental health and addiction services across NY and across the country are directly related to the tactics insurers and their vendors use to make it nearly impossible for providers to stay in network and for beneficiaries to USE their insurance without suffering extreme consequences. This is unacceptable.

Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill.nytimes.com • 21 min read