Are you against a ‘ghost network’ for mental health care? Here’s what you can do

It’s hard to know if your health insurance plan is as good as advertised. You pay a monthly fee to access a network of health providers. But call the numbers in your provider’s directory, and you’ll find those who can’t – or won’t – see you.

These errors are at the heart of the spiritual network. Some contributors have moved, retired or died; others left the insurance network because of low wages and strict screening. Even if these brokers no longer accept your insurance, their names may remain in the book. When that happens, policyholders are left to believe that the plan has more options than there are.

“Any inaccuracy makes the internet,” said Abigail Burman, a consumer protection attorney who studies provider listing errors. “This is basic news. It has to be good. ”

The failure of insurers to correct these mistakes has led to dire consequences for people seeking mental health care, as shown by a recent ProPublica investigation of one man’s months of struggling to get treatment. Due to the widespread nature of ghost networks, some policyholders are likely to pay out-of-network costs and face a greater chance of treatment delays – if they receive treatment in once.

ProPublica spoke with experts, doctors and lawyers to understand the problems posed by donor list errors. They all recommended specific ways for policyholders to manage the air network.

How much do insurers know about errors in their directories? And what should they do about it?

Insurers have acknowledged the problem and in some cases have vowed to address it. AHIP, the national association of health insurers, said in a 2023 statement to the US Senate Finance Committee that insurers update provider directories through “regular phone calls, emails, reminders of online and visiting in person.” However, AHIP wrote that insurance companies are unable to correct errors quickly because providers sometimes fail to maintain their personal identification information. (AHIP declined ProPublica’s request for an audit.)

But Dr. Robert Trestman, a Virginia psychiatrist who testified about cybercrime to the same committee, told ProPublica that insurers are able to track “every detail of funds” in things like billing and code entry. As a result, he said, insurers fail to “create a way to keep track of who is online or not.”

But insurers don’t have to make it a priority. Simon Haeder, a professor at Texas A&M University who studies ghost networks, said that insurers have “very little incentive” to monitor directories carefully. Unless stricter regulations are passed, he said, policyholders will continue to struggle with directories that contain “inconsistent, outdated or incomplete data.”

For years, it has fallen to academic researchers and private consumer research to uncover the prevalence of these errors. Lawmakers have passed bills and called for more changes. However, errors are still a concern for policyholders.

I buy a policy. How do I know it’s as good as advertised?

Do your homework. When an insurer doesn’t make it a priority to update its directory, the task of checking its accuracy falls on you. You can go to the website of the insurer whose life plan you want to buy. Access the client portal. Since insurance may offer different networks for each plan, experts suggest double-checking that you are looking for providers that are available in the network you want.

If you already have a service provider, type in their name to see if that person is listed online. If you don’t have one, find a provider who is listed online and accepting new patients, and who seems to meet your needs. From there, experts recommend reaching out to the client directly to make sure both things are true.

“Verify, verify, verify,” said Dr. Jane Zhu, an assistant professor at the Oregon Health & Science University School of Medicine who studies brain networks. “The accuracy of health provider directories is like a coin.”

I already have a health plan. What should I do?

Don’t worry if you have paid for the plan or have it through your employer. There are other ways to reduce the risks of supplier list errors.

But experts say you’ll need to arm yourself with some information.

Follow your “Security Credentials.” The document, which is usually around 100 pages in length, explains what your insurer must do to fulfill the contractual obligations. For example, if you can’t find an in-network mental health provider for a while, the insurer may be on the hook for an out-of-network provider.

From there, you can call the insurer to find out if it handles mental health benefits or has an outsourced policy. If those benefits are “excluded” from your plan, you may have to seek answers about the provider’s listing errors from that contractor. (If you encounter errors in your book, this information can be useful.)

Experts say that by getting these answers, you will be better able to fight for your rights.

What should I do if I encounter errors in the donor list?

Health care professionals warn that you may encounter errors in the provider’s manual. They advise you not to be discouraged if you do.

David Lloyd, chief strategy officer at mental health advocacy group Inseparable, suggests writing phone notes to providers. Did they answer the phone? Did they agree to your plan? Are they seeing new patients? You can write all of your information down on this handy page created by Cover My Mental Health, an Illinois-based consumer advocacy group. Take pictures of directory errors, too.

How many calls am I expected to make?

Some policyholders have called at least 50 so-called network providers in order to get an appointment. But experts say you shouldn’t contact so many people. Burman suggests making “due diligence.” For him, that means making five to 10 phone calls to network providers.

She and others recognize that if you’re struggling with mental health, you don’t have to call alone.

“Ask a friend or family member to help and advocate for you,” said Wendell Potter, a Cigna vice president who is now a consumer advocate.

None of my calls got an appointment. What should I do now?

If you have made such efforts and have not been able to close the carrier, experts recommend calling your insurance carrier. Notify the customer service representative that you were unable to make an appointment with the service provider despite multiple attempts. Ask the salesperson to make an appointment for you. Then ask for the agent’s email address and write a request – and ask the agent to respond in kind.

Meiram Bendat, a lawyer and psychiatrist in California, suggests reminding insurers that they “must share in the responsibility of identifying timely and geographically available service providers.” The exact rules depend on where you live and the type of plan you have, so some research may be required before calling. In some cases, you can request a care manager and the insurance will assign a worker who can help keep the mental health appointment.

“Set the expectation that a customer service representative needs to solve this problem,” said Joe Feldman, founder of Cover My Mental Health.

If the agent doesn’t connect you with the provider, health insurance experts recommend asking the rep to file an administrative complaint. Persistence is key, Burman said. Be assertive. Ask for the complaint to be resolved – or escalated to a manager who will resolve your issue.

“Don’t feel like you’re the problem,” Burman said. It is the problem of engaging in deceptive practices.

My ghost network complaint has not been resolved. Now what is it?

While you wait for your insurer to act, health insurance experts also recommend reaching out to your insurance adjuster.

Finding that manager can be a tricky task given America’s complex insurance laws. You will need to know which government agency oversees your insurance. Although more research is needed to see who will be able to help, experts point to the following organizations as a start:

1. If you purchased a plan through the Health Insurance Marketplace, or have a comprehensive health insurance plan through your private employer, you can contact your state’s insurance department.
2. If you have a Medicaid plan, you can contact your Medicaid agency.
3. If you are enrolled in Medicare, you can reach the Centers for Medicare & Medicaid Services.
4. If you have a self-employment plan from your private employer or a health and welfare benefits plan from your organization, you can try the US Department of Labor’s Employee Benefits Administration Benefits Security.

Once you find the right agency, experts suggest that you fix your complaint. You don’t need to write a new one from scratch. Gather the information from your complaint, along with any new changes, and take it to the manager.

Is there anything else I can do?

Yes, there are a few other ways. No matter how you approach it, Potter encourages you to make noise, as if you were a “squealing wheel.”

If you are covered by an employer’s health plan, see if your human resources department can help talk to the insurer.

Or contact the district service offices of your local and state attorneys general. They may be able to reach directly, too.

Depending on where you live, there may be legal services or consumer advocacy organizations that can help you.

“As a consumer, your biggest power is not moving,” Burman said. “Your most powerful weapon, in the face of a company that wants you to leave, is not to leave.”