Medical experts urged Congress to hold insurance companies accountable for inaccurate medical directories that can hamper access for patients seeking mental health treatments.
The problem, referred to as a “ghost network,” occurs when health insurance providers ostensibly provide coverage, but direct customers to nonexistent or unavailable doctors and providers.
“In my view, it’s a breach of contract for insurance companies to sell their plans for thousands of dollars each month, while their product is unusable due to a ghost network,” Senate Finance Committee Chair Ron Wyden (D-Ore.) said at a hearing Wednesday.
“And in a moment of national crisis about mental health, with the problem growing at such a rapid rate, the widespread existence of ghost networks is unacceptable.”
Committee staff found that more than 80 percent of mental health providers found in insurance directories from 12 plans in six states were unreachable, not accepting new patients or were not in-network, according to a secret shopper study.
Experts said the problem can have serious consequences for patients seeking psychiatric care or other mental health treatments.
“For people experiencing significant mental illness or substance use disorders, the process at best is demoralizing, and at worst is a setup for clinical deterioration and a preventable crisis,” said Jack Resneck, president of the American Medical Association.
Resneck added that ghost networks are “both a cause and a symptom” of a flawed health care system and that Congress should consider penalizing insurance companies for misleading consumers.
“This is one area where we actually need congressional help,” Resneck said. “If we don’t have monetary penalties on these plans for continuing to put out these fake networks to make these fake directories to make their networks look bigger than they are, we’re not going to make progress.”
Senators proposed multiple solutions, including supporting more telehealth treatment to increase accessibility, especially in rural areas where mental health care access is limited.
Lawmakers also said that Congress could standardize how insurers collect information or audit providers through the Department of Health and Human Services or the Centers for Medicare and Medicaid Services.
“It’s shocking to me that [insurers] don’t have an audit program of record where they’re going through their provider networks,” Sen. Thom Tillis (R-N.C.) said.
Ranking member Sen. Mike Crapo (R-Idaho) said solutions should avoid burdening the mental health workforce and place responsibility on insurance providers to be more accurate and transparent.
Additionally, ghost networks disproportionately affect marginalized populations and people in low-income communities, said Keris Jän Myrick, vice president of partnerships for the mental health nonprofit Inseparable.
“Ghosts networks erect invisible unexpected barriers within our health systems, preventing people from accessing the care and support that they need,” Myrick said.
“They are particularly damaging for those of us living with serious mental health conditions like me, as they can result in delayed or inadequate treatment or even going without treatment, any of which can be devastating and have devastating consequences.”
