Fighting the Phantoms of Managed Care: Legislation in California and a Legal Case in Virginia Address Managed Care's Practice of Maintaining Phantom Provider Panels

Daw, Jennifer

doi:10.1037/e300012003-016

Cited by 1 publication

(5 citation statements)

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“…Further, MCO directories inaccurately list the level of care afforded to the low-income publicly insured, which creates inequities to accessing care from licensed general dentists, and policy efforts may want to provide transparency in online classifications (i.e., student dentists) describing available care. Our research aligns with the available literature scrutinizing inaccurate provider listings that limit accessibility or prevent availability of healthcare [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Discussionsupporting

confidence: 73%

“…Our novel study fills a gap in the literature concerning dental care phantom networks. The phenomenon of phantom networks, inaccurate provider listings, has been observed in both private and public insurance directories, traversing various health disciplines for over two decades [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. We were astonished to find that over two thirds of the dentists surveyed were classified as phantom networks.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, facilities serving only adults were still counted as general providers because access for this population is more limited, as Medicaid dentists may prefer to serve children [ 35 , 37 , 74 ]. Daw [ 16 ] originally defined phantom networks as a group of providers not participating in an insurance plan or no longer accepting new patients under the plan. We modify and expand this definition to include multiple errors in MCO directories of available providers that overstate access to care.…”

Section: Materials and Methodsmentioning

confidence: 99%

“…Utilizing the multifaceted “Access framework” for general healthcare as reconceptualized from Lipson et al [ 15 ], this paper examines Medicaid recipients’ dental care access issues, with a focus on the dimensions of availability, accessibility, and accommodation among MCO listed providers. In terms of availability, healthcare providers inaccurately listed as participating in an insurance plan constitute “phantom networks” [ 16 , 17 ]. For over two decades, the phenomena of phantom networks and inaccurate insurance provider directories were found across numerous geospatial locations and multiple medical disciplines, dispersed among both private and public health organizations [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…In terms of availability, healthcare providers inaccurately listed as participating in an insurance plan constitute “phantom networks” [ 16 , 17 ]. For over two decades, the phenomena of phantom networks and inaccurate insurance provider directories were found across numerous geospatial locations and multiple medical disciplines, dispersed among both private and public health organizations [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, there is a lack of research about dental phantom networks, and this study will explore and expand the topic to better understand this multidimensional phenomenon.…”

Section: Introductionmentioning

confidence: 99%

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How Phantom Networks, Provider Qualities, and Poverty Sway Medicaid Dental Care Access: A Geospatial Analysis of Manhattan

Kelley

Sun

2021

IJERPH

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Access to general dental care is essential for preventing and treating oral diseases. To ensure adequate spatial accessibility for the most vulnerable populations, New York State mandates a ratio of one general dentist to 2000 Medicaid recipients within 30 min of public transportation. This study employed geospatial methods to determine whether the requirement is met in Manhattan by verifying the online directories of ten New York managed care organizations (MCOs), which collectively presented 868 available dentists from 259 facilities. Our survey of 118 dental facilities representing 509 dentists revealed that significantly fewer dentists are available to treat Medicaid recipients compared to MCO directories. The average dentist-to-patient ratio derived from the MCO listings by the Two-Step Floating Catchment Area (2SFCA) method was 1:315, while the average verified ratio was only 1:1927. “Phantom networks”, or inaccurate provider listings, substantially overstated Medicaid dental accessibility. Surprisingly, our study also discovered additional Medicaid providers unlisted in any MCO directory, which we coined “hidden networks”. However, their inclusion was inconsequential to the overall dental supply. We further scrutinized dental care access by uniquely applying six “patient-centered characteristics”, and these criteria vastly reduced accessibility to an average ratio of merely 1:4587. Our novel evaluation of the spatial association between poverty, dental care access, and phantom networks suggests that Medicaid dental providers wish to be located in wealthier census tracts that are in proximity to impoverished areas for maximum profitability. Additionally, we discovered that poverty and phantom networks were positively correlated, and phantom providers masked a lack of dental care access for Medicaid recipients.

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