Watch the Video
Reported by: Hagit Limor
Produced and Photographed by: Phil Drechsler
Web produced by: Laura Hornsby
It’s a call for help, a call of desperation: Every day, people in the Tri-State reach out for mental health care, from marriage counseling to children’s issues to thoughts of suicide.
But many are complaining that one large insurance company isn’t providing the help it’s promised.
The I-Team’s Hagit Limor has been investigating since last summer.
That’s when we first told you that the governor of Ohio was asking for an investigation after we made him aware of complaints about Anthem Insurance company.
Since then, the I-Team’s continued to get complaints that the situation is getting worse. So we decided to test the system ourselves, and to find out what happened to that state investigation the Governor promised.
We first met with Kate, and her 22-month-old son, Coen.
"It’s frustrating. Really frustrating," she said. Kate’s been struggling to find someone, anyone, she and her boyfriend could see for relationship counseling.
"You only have a short list of people that you can even call, and when you call them they are like, ‘Well, we are not accepting you because you have Anthem.’"
Kate started with Anthem’s online list of therapists she could see in-network.
She called Anthem’s customer service line to confirm. "It was like one person after the other. They were either had just been dropped by Anthem or they dropped Anthem themselves. I’m like, ‘Are you kidding me? Why do you even have them on your website then, as in-network and covered on my plan?’"
Kate says it took hours on the phone to find that of close to 50 names, only eight still accepted Anthem patients, and of those eight, the first five said she couldn’t get an appointment.
"It does not pay for us to take Anthem. It does not cover our overhead," said an office manager for a local psychiatrist's office who asked us to hide her identity because she fears retaliation from Anthem. She says she hears from patients like Kate every day.
"One of their big complaints is that ‘You are the 14th doctor I’ve called. Are you taking Anthem, period?’ They have called everywhere and they can’t get in or it’s a three- to six-month wait. And they need help right now."
The problem, she says, is that Anthem cut what it pays therapists so significantly, that even ‘though her office officially takes Anthem patients, in reality when they call, "You have to tell them, ‘I’m sorry. We are full. We have no openings. It’s hard to discriminate but we have to screen them. We can’t even provide the care. We can’t afford to."
And she says many other practices are doing the same thing. So the I-Team decided to test Anthem’s list on its website with random calls. Our intern called mental health providers and asked if they were taking new Anthem Patients.
Here’s what we heard from office after office:
"He is not accepting new patients." "She’s no longer with our agency." "He’s not accepting Anthem patients."
We heard this every call.
"There is clearly a problem," says David Ranz, executive director of Hamilton County’s branch of NAMI, the National Alliance on Mental Illness. "I think it has become a much bigger problem but it’s still below the surface and it is important that it is exposed to the light of day," he said.
Ranz says he’s hearing daily from parents unable to get care for kids, patients paying out of their own pockets to get any care at all, and some waiting months for an appointment. "We who have loved ones that have serious mental health issues, a four- to five-month wait is not acceptable. Your loved one is in crisis."
The I-Team did a second test we shared with NAMI. We called Anthem’s list of all 17 mental health providers at Cincinnati Children’s Hospital. Only five were even seeing outpatients or accepting new ones. Of those, two only would take you for a bipolar study. One left at the end of January, leaving two, and even they couldn’t see you ‘til May or June.
We asked Ranz, "Is it truth in advertising if you put out a book that says, ‘All these people take our patients’ when clearly, they don’t?" "No, it’s clearly not," he said.
Ohio Governor Ted Strickland says he’s instructed the state Department of Insurance to look into what we’ve found. "That’s what they are trying to monitor, to make sure that Anthem and/or no company makes false claims about what they are providing to their clients."
Governor Strickland first asked the Department of Insurance to look into the I-Team’s investigation after our first report in July. The Department concluded that after "a thorough review of the issue… we found no violation of existing Ohio… law."
But the I-Team then learned that all the information in that "thorough review" came directly from Anthem. So we told the state about our spot checks of Anthem’s list. The Governor spoke to the Director of Insurance: "And she told me that they are continuing their investigation and their monitoring of this situation," he said.
One group that’s stopped monitoring Anthem is Hamilton County. It switched insurers after our July report. Anthem wouldn’t talk to the I-Team - and we asked repeatedly - but released a statement that says "We can confirm that Hamilton County did switch health insurance carriers, but the primary reason had nothing to do with behavioral health access."
But county commission president Todd Portune says it did play a role in his decision. "I can tell you with respect to my own decision, this was an element of my decision about who the proper carrier was to go with." Portune said it convinced him to vote to switch to Humana instead. The commission vote was 2-0. One commissioner was absent.
"Their consumers are being cheated out of access to providers," says psychologist Dr. Jean Deters. She risked the retribution she fears from Anthem to speak out. "The only reason that I am talking to you or the I-Team is because my patients deserve the best care," she says, "And when somebody is in need, whether it would be in depression or suicidality, substance abuse, divorce, all these things that do come into families’ lives, the last thing they need to be doing is sitting on the phone with an insurance company for hours just to determine whether or not they are allowed to access the care that was already promised to them."
Again, Anthem denied our repeated requests for an interview. In their statement they stressed that "All Anthem members have, and will continue to have, access to behavioral health care."
That’s an issue everyone from the psychologist, to the office manager, to the patient, to the mental health advocate urged the state to spot check, to conduct a blind shopper study of Anthem’s list.
Several warned us that some people are so discouraged they’re giving up on care. They said the Virginia Tech shootings serve as prime example of what can happen when people with untreated mental illness fall through the cracks.
People experiencing similar problems can complain to the Department of Insurance, now reviewing new information we brought to their attention. They also can call NAMI to get help finding a provider. And Anthem told us to have consumers call them directly if they need help. We have links and contact information on our website, as well as complete statements from Anthem and the Department of Insurance.
