The purported strength behind managed-care companies is their panel of providers. Typically, companies advertise the stability and breadth of their panels to draw potential customers, while paring down their provider panels to cut costs.
So provider lists are not always correct or up-to-date. "When a consumer tries to access the promised benefit, he or she finds that many of the health professionals on the provider list are simply 'phantoms' of managed-care marketing and not really available," says Russ Newman, PhD, JD, APA's executive director for practice.
These "phantom panels" can lead employers to make uninformed purchasing decisions and cause consumers big headaches.
"Consumers are being forced to go from one plan to another and are finding that the lists of providers are inaccurate," says Charles Faltz, PhD, director of professional affairs for the California Psychological Association (CPA). "And it's at best confusing for psychologists. They are being buffeted from pillar to post."
To combat this problem, CPA and several other health-care groups took to the state capitol and last fall, the state legislature passed a phantom network bill, which takes effect on July 1.
The new law requires health-care service plans, when requested by an enrollee or prospective enrollee, to provide a list of contracting health-care providers--and that the list indicate which providers are no longer taking new patients. The law also requires that disclosure forms include any limitations on patients' choice of non-physician health-care practitioners and the requirements for referrals to those practitioners.
"Consumers have a right to know what they are getting and to be informed," says Newman. According to Alan Nessman, JD, special counsel for APA's Practice Directorate, the California law is the first legislation that explicitly addresses phantom panels. "The legislation really puts companies' feet to the fire on this practice," he says.
Faltz says there wasn't a single dissenting vote when it came time for a final vote. "I think the ratification of this bill shows how much support there really is in the public," he says, noting that he hopes the California phantom panel law will spark legislation in other states. That may happen soon. New York and Pennsylvania governments are investigating the problem.
Meanwhile, another effort to ensure accurate managed-care disclosure has developed in Virginia through a legal route. The APA Practice Organization is supporting the Virginia Academy of Clinical Psychologists (VACP) in a case against Blue Cross/Blue Shield of the National Capital Area and four other managed-care companies, including Value Options, one of the nation's largest managed mental health-care companies.
The plaintiffs in the case--VACP, six psychologists and two consumers--allege that Blue Cross advertised a large, stable panel of mental health professionals as part of its health maintenance plan. But then payment rates for psychologists on the plan's provider panel were slashed by more than 30 percent, allegedly driving a large number of providers off the panel. But the dramatic change in the size of the provider panel didn't spark a change in Blue Cross's advertising.
APA officials expect a decision following a pending summary judgment motion on the case in the coming months, and trial shortly after that.
Both the new law in California and the Virginia legal battle are "a consistent part of the evolving strategy to halt the egregious practices of managed care," says APA's Newman.