ProPublica, a nonprofit newsroom focused on investigating abuses of power, emphasizes the challenges individuals face in evaluating their health insurance plans. Despite paying monthly premiums for access to a network of health providers, many policyholders encounter difficulties when attempting to schedule appointments with the listed providers. This issue, often referred to as a “ghost network,” includes providers who have moved, retired, or passed away, as well as those who have left the network due to low pay or intense scrutiny.
Abigail Burman, a consumer protection attorney specializing in provider directory errors, defines any inaccuracy as contributing to a ghost network, noting the importance of maintaining accurate information. The persistence of these errors has serious implications for those seeking mental health care, often leading to out-of-network costs and treatment delays.
ProPublica’s investigation into these errors has revealed significant consequences. Policyholders struggle with directories that display inconsistent, outdated, or incomplete data. Although insurers have acknowledged this problem and claimed to take action, actual results have been limited. AHIP, a national health insurers’ association, stated in a 2023 document to the U.S. Senate Committee on Finance that insurers use various methods to update provider directories, but they often face challenges when providers fail to update their own information.
Dr. Robert Trestman, a psychiatrist who has testified about ghost networks, criticized insurers for not setting up systems to accurately track network providers. Texas A&M University professor Simon Haeder added that insurers have little incentive to closely monitor directories without stricter regulations.
Despite efforts from academic researchers and secret shopper surveys, errors persist, compelling policyholders to independently verify information. Experts recommend thorough research before purchasing a plan. This includes visiting insurers’ websites to check the provider portal and contacting listed providers directly to confirm their network status and availability.
For those already enrolled in a plan, experts suggest obtaining the “Evidence of Coverage” document to understand contractual obligations and how to address directory errors. Policyholders are also advised to contact their insurers to clarify management of mental health benefits and document all interactions and errors encountered.
Health care experts recommend persistence in addressing these issues. If initial efforts fail, policyholders should request their insurers file an administrative grievance and escalate matters if necessary. Furthermore, they can reach out to appropriate regulatory agencies based on their insurance type.
Taking additional steps, such as seeking help from human resources departments, elected lawmakers’ offices, or consumer advocacy agencies, may also be beneficial. Ultimately, experts emphasize the importance of persistence, with Burman stating that a consumer’s strength lies in their determination not to give up.
ProPublica continues to investigate mental health care access and invites individuals with insights to share their experiences.
