While on the surface healthcare and business reporting seem to exist in separate spheres, a deeper look reveals that they overlap and even influence each other. That’s because in countries like the United States, healthcare is a business with investors, profits, financial risks, and debts.
Max Blau, a healthcare reporter for ProPublica, explores the symbiotic relationship between healthcare and business and how it impacts its patient-customer subjects in his latest story, “‘I Don’t Want to Die’: Needing Mental Health Care, He Got Trapped in His Insurer’s Ghost Network.”
The story follows Ravi Coutinho, a man who purchased an insurance policy through the American health insurance company Ambetter with the goal of receiving mental health care to address his depression, anxiety, and alcohol addiction. At the time of purchase, Ambetter – owned by Centene Corp. – was listed as the most popular insurance network on HealthCare.gov, offering ample provider options. That claim, however, turned out to be false, leaving Coutinho stranded in a “ghost network.”
Millions of Americans have found themselves in the same position, paying for a health network that, on paper, is robust but in reality is much more limited as their directories of care providers reflect incorrect and out-of-date information. Many of these providers have retired, passed away, are not taking new patients, or no longer accept insurance, often because insurance companies make it nearly impossible for psychiatrists and therapists to stay in-network.
Blau spoke with The Reynolds Center about the behind-the-scenes reporting for this piece, from the intersection of business and healthcare reporting and the value of in-depth interviewing to the importance of approaching stories as humans first and as reporters second.
Healthcare reporting is business reporting
“I would argue that all healthcare stories are business stories for the most part, in the sense that our healthcare system is a profit-driven series of systems,” Blau said. Health insurance customers analyze the market and purchase a service that best meets their needs based on its price, quality, and reliability.
From a business standpoint, Blau compared ghost networks to someone’s purchase of an electric vehicle from a dealer that promises 1,000 EV charging stations within a certain radius, only to realize after purchasing that there are no changing options at all within that area. “That is a misrepresentation of the product that you are buying,” Blau said.
As with any investigative story, the aim is to expose wrongdoing and hold the responsible parties accountable. Blau hopes that his reporting shines a light on the widespread problem of ghost networks and leads to legal accountability for insurance companies to follow through on their promises to customers. He added, “Health insurance is a great American promise: We pay for the ability to access care when we need it. That ability shouldn’t be compromised by a gatekeeper.”
Leveraging in-depth interviewing
A story about provider-directory errors might not sound interesting to most audiences. However, a story about a person struggling with mental health who was failed by his insurance due to provider directory inaccuracies will likely appeal to a wide range of readers.
“Getting close to Ravi’s experience breaks through that concern about people not caring about provider directory errors,” Blau said. The microcosm of Coutinho’s lived experience opens the door to exposing an industry-wide problem while showing the real-life ramifications that insurance companies’ false advertisements have on everyday Americans.
Coutinho’s numerous attempts to access mental health care through Ambetter were unsuccessful; the 36-year-old’s mental health and alcohol addiction worsened, leading to his death on May 27, 2023, less than five months after joining the network.
Blau was careful to depict Coutinho as a complex and multi-faceted person, rather than reduce him to his mental health struggles or a mere example of the systemic issue. Blau spent about 25 hours interviewing the people who knew Coutinho best.
“I probably knew most of Ravi’s story, maybe within the first five or 10 hours of the interviewing I did,” Blau said. “But by having those additional layers of interviewing and going for more poignant details… you are then able to go from having just a really interesting anecdote to a very compelling narrative that allows you to bring someone to life.”
You’re a human being before you’re a reporter
Reporting on the story of someone who has passed away poses a significant challenge: the main source of the story can’t corroborate any information. Blau was fortunate enough to have the full support and cooperation of Coutinho’s mother, Barbara Webber. “I admire the courage that Barbara had as well as her willingness to work with me to go get records that I could not otherwise get,” Blau said.
Another challenge is that the sources you can talk to about a deceased person are often managing grief and other complex emotions.
“I don’t think there’s a way of doing it other than to give people the time and space that they need and to also, as you are reporting, to be transparent and honest,” Blau said. Reporting on healthcare, business or any other beat with a person-first approach is conducive to journalism that minimizes harm, which according to the Society of Professional Journalists, is foundational to ethical journalism.
For more insights on healthcare reporting through a business lens, check out “Chapter 8: Insurance” of The Reynolds Center’s Business Beat Basics: A Guide to Covering All Things Business.
