Springfield, IL – 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 commended the House Mental Health and Addiction Committee for passing HB5313 out of committee with unanimous support. The legislation, introduced by State Representative Margaret Croke, would 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.
“Patients seeking out mental health services should be able to rely on their insurance provider’s directories to identify an in-network provider and get the care they need,” said State Representative Margaret Croke. “I’m grateful to my colleagues on the House Mental Health and Addiction Committee for passing my bill to eliminate ghost networks out of committee, and I look forward to passing this bill in the coming weeks to improve access to mental health care for Illinoisans across our state.”
The earlier an individual gets treatment for a mental health condition, the lower the cost and the better the outcomes. Delayed treatment worsens conditions, making them harder and more complex to treat later. Of the two million Illinoisans with a diagnosed mental health condition, a shocking 23% of those with commercial insurance received care from a mental health specialist each year. One of the primary reasons individuals don’t get the treatment they need is that they can’t find available providers within their health insurer’s network.
While insurance companies are required to make provider directories available for consumers, research shows these directories routinely mislead customers by mischaracterizing available providers or including “ghost networks” that are not actually available to people enrolled in a plan. In a recent survey, over half of consumers with commercial insurance reported provider directory problems that made it difficult to find mental health care.
“Ghost networks represent a broken promise from insurers to their policyholders. Rather than finding the help they need, families seeking mental health and addiction care are instead forced to navigate a maze of inaccurate information, unavailable providers, and even providers who are not actually in network,” said David Lloyd, Chief Policy Officer at Inseparable. “We applaud the House Mental Health and Addiction Committee for passing this important legislation today and are grateful to State Representative Margaret Croke for her leadership on this important issue.”
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 directories every 90 days and make any necessary corrections.
HB5313 now heads to the full House for consideration. Learn more about the bill on ILGA.gov.