Mental Health Patients With Insurance Often Hit Ghost Networks, Study Finds

Having health insurance does not mean being able to see a mental health professional, according to a study that tested the provider lists of commercial insurance plans by calling the clinicians on them.

Researchers at The Ohio State University, working with a co-author from Stanford, posed as patients seeking help for problems such as anxiety and grief. They called 5,822 psychiatrists and psychologists listed as in-network by commercial insurers in five states: Delaware, Montana, New Jersey, Rhode Island and Virginia. The findings were published in the journal JAMA Health Forum and described by the university this week.

More than six in 10 calls never reached a person, ending instead in automated systems or voicemail, so the team analyzed the remaining 2,252. Of those, 24 percent led to an appointment with the clinician who was listed. When callers were willing to see anyone in the practice, the share rose to 31 percent.

The problems were often basic. Directory information was wrong in 56 percent of the analyzed calls, the researchers reported, with listed clinicians who had moved, changed numbers or left a practice. In 22 percent of calls, the obstacle was capacity, such as a provider not taking new patients. Even when appointments were offered, callers waited an average of about 20.5 days, with longer waits for psychiatrists than for psychologists.

Health policy researchers call lists like these ghost networks: directories that include clinicians who are not, in practice, available to a plan’s members. For a patient in distress, each wrong number or full practice is another obstacle between paying premiums and getting care.

Wendy Xu, one of the lead authors, described the findings as showing a disconnect between holding insurance and being able to use it. Simon Haeder, the other lead author, attributed the problem partly to uneven regulation and enforcement, and to incentives for insurers to make their networks look larger than they are. He said he would like to see a centralized directory that clinicians themselves keep current.

There is a fair point on the insurers’ side: clinicians change jobs, practices and phone numbers constantly, and keeping millions of directory entries accurate is genuinely difficult. But the scale of the errors found here, in more than half of the calls analyzed, suggests the burden of that difficulty is falling mostly on patients.

The study was limited to commercial plans in five states, so it does not show how public programs or other states compare. Within those limits, the finding is stark: the networks printed in insurance directories often bore little resemblance to the care callers could actually reach.