CHICAGO – Inseparable, a national organization focused on closing the treatment gap for people with mental health conditions, improving crisis response, and supporting youth mental health, today applauded the introduction of legislation in the General Assembly to improve access to mental health treatment by eliminating “ghost networks,” or provider networks that are filled with providers who are not actually in-network, not taking new patients, no longer in the same location, or not even practicing at all. The bill, HB5313, was recently introduced by State Representative Margaret Croke (IL-12) to ensure that enrollees seeking a mental health care provider can rely on accurate provider directories from their health plan.
“Seeking out mental health services can be intimidating, and we must make it as easy and transparent as possible for people to find a provider that’s covered by their insurance so they can get the care they need,” said State Representative Margaret Croke. “I’m proud to introduce HB5313, which will require insurance providers to eliminate ghost networks and provide accurate directories for in-network mental health care. I’m grateful for the support of Inseparable, an organization fighting each and every day to close the mental health treatment gap across the country.”
While insurance companies are required to make provider directories available for consumers when selecting a health plan or looking for an in-network provider, research shows that these directories frequently mischaracterize available providers or include “ghost networks” that are not actually available to people enrolled in a plan. Research also proves the importance of ensuring people get the treatment they need – delays can cause conditions to worsen, a rise in additional health concerns, and a dramatic increase in costs.
“No one should get the mental health care they need through a provider they believe is in-network, and then find out the provider was not actually in-network and be left with an unexpected bill to cover the cost,” said David Lloyd, Chief Policy Officer at Inseparable. “Insurance providers owe it to their customers to provide accurate information about their mental health care providers so people can get affordable, necessary care. We are thankful to Representative Croke for championing this legislation, and look forward to seeing it pass the General Assembly this spring.”
HB5313 would expand what a plan must disclose in its provider directories to include a description of how to dispute charges for out-of-network providers that were incorrectly listed as in-network prior to the provision of care, including a phone number and email address. It would allow consumers to recoup out-of-pocket expenses if they were charged out-of-network costs for a provider that was listed as in-network in their provider directory. HB5313 would also require plans to audit at least 25% of its provider directories annually and make any necessary corrections, and would also require the Department of Insurance to randomly audit at least 10% of plans each year.
To learn more about HB5313, read more on ILGA.gov.