“Ghost networks” refers to when health insurance plans list providers in their network that are not actually available. The problem is widespread in mental health care, according to a ProPublica report. Stone RF/PM Images/Getty Images Hide caption
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It’s hard to know if your health insurance plan is as good as advertised. You pay a premium every month to have access to a network of providers, but when you call the numbers in the provider directory, you’re sure to find providers who can’t or don’t want to see you.
These errors are at the root of ghost networks. Some providers have moved, retired, or even disappeared. Others have left insurance networks due to low wages and intense oversight. These providers may no longer accept your insurance, yet their names remain in the directory. This leaves policyholders with no choice but to believe their plan has more options than it actually does.
“Any information that’s inaccurate constitutes a ghost network,” said Abigail Berman, a consumer protection attorney who studies provider directory errors. “This is basic information. It has to be accurate.”
Insurers’ failure to correct these errors has had dire consequences for people seeking mental health care, as revealed by a recent ProPublica investigation in which one man struggled for months to receive treatment. Because ghost networks are so prevalent, some insured people are more likely to pay out-of-network costs and delay care without knowing if it will even be available.
To understand the challenges posed by provider directory errors, ProPublica spoke with experts, clinicians and advocates, all of whom suggested specific ways insured people can navigate ghost networks.
How much do insurers know about the errors in their directories, and what should they do about it?
Insurers have acknowledged the problem and vowed to address it in some cases. Insurers update their provider directories through “regular phone calls, emails, online reminders and in-person visits,” the National Association of Health Insurance Plans (AHIP) said in a statement to the U.S. Senate Finance Committee in 2023. But AHIP wrote that insurers can’t always quickly correct errors because providers sometimes fail to keep their own specialty information up to date. (AHIP declined ProPublica’s request for an interview.)
But Dr. Robert Trestman, a Virginia psychiatrist who testified about ghost networks before the same committee, told ProPublica that insurers can track “every detail of finances,” including billing and coding, so it’s the insurers’ fault for failing to build systems to track who is and isn’t in-network, he said.
But insurers haven’t had to make it a priority. Simon Hader, a professor at Texas A&M University who studies ghost networks, said insurers have “little incentive” to monitor directories closely. Unless stricter regulations are passed, policyholders will continue to be plagued by directories full of “inconsistent, outdated and incomplete data,” he said.
The prevalence of these errors has been documented by academic researchers and secret shopper studies for years, and lawmakers have passed bills and called for further reform, yet these errors continue to plague policyholders.
I’m looking for a plan. How do I know if the plan is as good as advertised?
Do your homework. If your insurer doesn’t prioritize updating its directory, it’s your job to make sure it’s accurate. Visit the insurer’s website for the health insurance plan you’re considering purchasing and find the provider portal. Insurers may offer different networks for different plans, so experts recommend double-checking that you’re only searching for providers available in your preferred network.
If you already have a provider, enter their name to see if they’re listed in-network. If you don’t have a provider, find one that’s listed in-network, accepting new patients, and likely to meet your needs. From there, experts recommend contacting the provider directly to verify that both are true.
“Verify, verify, verify,” says Dr. Jane Chu, an associate professor of medicine at Oregon Health & Science University, who has studied ghost networks. “The accuracy of a directory of behavioral health providers is like a coin flip.”
I already have health insurance, what should I do?
Don’t worry if you already pay for a plan or have one through your employer: There are other ways to minimize the risk of provider directory errors.
But experts say you need to be prepared with some facts.
Look for a “Proof of Coverage.” This document is usually around 100 pages long and outlines what the insurance company must do to meet its contractual obligations. For example, if you can’t access an in-network mental health provider within a certain period of time, the insurance company may be obligated to find an out-of-network provider.
From there, you can call your insurance company and find out if they handle your mental health benefits or outsource the administration of those benefits. If those benefits are “carved out” of your plan, you may need to ask the subcontractor for answers about errors in their provider directory. (This information may be helpful if you find errors in the directory.)
Experts say having these answers will enable you to fight more effectively for your rights.
What should I do if I get a provider directory error?
Medical experts warn that it’s likely you’ll come across errors in medical provider directories, and they advise not to be discouraged if you do come across one.
David Lloyd, chief policy officer at mental health advocacy group Inseparable, suggests taking notes of your calls to providers. Did the provider answer the phone? Did they say they’d accept the plan? Did they see a new patient? You can write all your notes on this handy worksheet created by Cover My Mental Health, an Illinois consumer advocacy group. Take photos of any errors in your directory, too.
How many calls should I make?
Some people with insurance call at least 50 in-network providers to get an appointment. But experts say you don’t need to contact that many. Berman suggests making a “reasonable effort.” For her, that means calling five to 10 in-network providers.
She and others point out that if you’re struggling with your mental health, you don’t have to make the call yourself.
“Ask friends and family for help and have them advocate on your behalf,” says Wendell Potter, a former Cigna vice president and now a consumer advocate.
I called but couldn’t get an appointment, what should I do?
If you can’t secure a provider after reasonable efforts, experts recommend calling the insurer again. Tell the customer service representative that you haven’t been able to get an appointment with the listed provider despite repeated attempts. Ask the representative to schedule an appointment. Then ask for the representative’s email address and put your request in writing. Then ask the representative to reply in the same way.
Mayram Bendat, a California attorney and psychotherapist, suggests reminding insurers that “you share the responsibility of identifying timely and geographically accessible providers.” Specific regulations vary depending on where you live and the type of plan you have, so you may need to do some research before calling. In some cases, you can ask for a care manager, and your insurer will assign you an employee who can secure mental health appointments for you.
“Set the expectation that a customer service rep needs to resolve this issue,” says Joe Feldman, founder of Cover My Mental Health.
If the agent won’t connect you to a provider, health insurance experts recommend asking them to file an administrative complaint. Persistence is key, says Berman. Be firm and demand that your complaint be addressed or escalate to a manager who can resolve your concerns.
“Don’t think you’re the problem,” Berman says. “They’re the problem, they’re committing fraud.”
My complaint about a ghost network has not been resolved, what should I do?
While you wait for your insurer’s response, health insurance experts also recommend contacting insurance regulators.
Insurance regulation in the United States is a complex web, so finding your regulator can be a daunting task. You’ll need to determine which government agency oversees insurance companies. Finding out who can help you will require more research, but experts point to the following agencies as a starting point:
If you bought a plan through your state’s health insurance marketplace or have a fully insured plan through a private employer, you can contact your state’s insurance department. If you have a Medicaid plan, you can contact your state’s Medicaid agency. If you have Medicare, you can contact the Centers for Medicare & Medicaid Services. If you have a self-funded plan through a private employer or a health benefits plan through a union, you can contact the U.S. Department of Labor’s Employee Benefits Security Administration.
Once you have found the right agency, experts recommend preparing your complaint. You don’t need to write a new complaint from scratch. Gather information about your complaint and any other new developments and submit it to the regulator.
Is there anything else I can do?
Yes, there are other ways to do this, and whatever approach you take, Potter encourages you to speak up, as if it were a “relentless squeaky wheel.”
If you have health insurance through your employer, see if your human resources department can help you negotiate with the insurance company.
Or, contact the constituency services offices of your federal and state elected officials. They may also be able to contact you directly.
Depending on where you live, legal services and consumer advocacy organisations may be able to help.
“Your superpower as a consumer is not to disappear,” Berman said. “When faced with companies that want you to disappear, your most powerful weapon is not to disappear.”
