California Assembly passes NUHW-backed “Ghost Network” bill
An NUHW-backed bill that would make California a leader in making health plans maintain accurate lists of in-network providers, including mental health therapists, passed the State Assembly this month by a 59 to 9 vote.
Assembly Bill 236, which now heads to the State Senate, aims to put an end to “ghost networks,” by requiring health plans to audit their own provider directories per standards set by the Department of Managed Health Care. Health plans would be required to achieve 80 percent accuracy by 2026 and 95 percent accuracy by 2028. Plans that fail to meet accuracy benchmarks would be fined.
“Ghost networks” are especially common in behavioral health and are a big problem for Kaiser Permanente patients.
In 2021, San Diego City Attorney Mara Elliott filed a lawsuit accusing Kaiser of intentionally and illegally overstating the number of mental health providers available to its 9 million members in California. According to the complaint, 38 percent of the psychologists, therapists and licensed clinical social workers listed in Kaiser’s provider directories were not actually available to care for Kaiser patients.
Sarah Soroken, a former Kaiser therapist and current NUHW associate member, went to the State Capitol several days before the vote to lobby legislators to pass the bill.
“It was a good opportunity to tell staffers for Assemblymembers who might have been on the fence about how I’ve seen “ghost networks” impact the clients and patients I’ve worked with,” Soroken said. “As a triage clinician at Kaiser, we would get people calling back saying they’ve been through all the names on the provider lists and couldn’t get appointments, and now their symptoms are getting worse.”
Soroken also recalled covering an Emergency Department shift when one patient had attempted suicide after going through provider lists and not being able to connect with a therapist.
“That’s an extreme case, but the struggle is real,” said Soroken, who also helped lobby lawmakers to pass SB 221, NUHW’s timely-access-to-care bill, and is ready to return to Sacramento later this year when the “ghost network” is debated in the State Senate.
“It’s clear that the federal parity law isn’t doing enough,” Soroken said. “So we need strong state laws that attack offending health plans from all angles.”