A bipartisan group of senators has called out large payers for their mental health “ghost networks,” which provide an inaccurate list of in-network providers.
“Ghost networks” often list providers no longer in-network, accepting patients, or having closed their practice. The lawmakers noted that ghost networks could lead to mental health access issues and make it challenging for patients to find in-network providers.
“Ghost networks sow confusion and frustration among patients who are often in need of immediate care,” the senators wrote in letters to the large payers. “Patients who lack the time and resources to sift through inaccurate provider directors may ultimately choose to forgo or delay needed health care. Others may be forced to pay out-of-pocket for a provider.”
Senators Tina Smith (D-Minn.), Ben Ray Luján (D-N.M.) and Steve Daines (R-Mont.) penned letters to Aetna, Anthem Blue Cross Blue Shield, Humana and United Healthcare. The lawmakers pointed out that while ghost networks are an issue across health care, they are widespread in behavioral health.
In the letters, the senators noted that the major payers must comply with the Consolidated Appropriations Act (CAA) of 2021, which was established to help protect consumers against surprise bills and increase transparency in health care.
The issue is particularly prevalent for Medicaid beneficiaries.
Over the summer, Health Affairs published a study on ghost networks, also called “phantom networks,” which found that 67.4% of mental health prescribers and 59% of mental health non-prescribers in Oregon’s Medicaid director were actually phantom providers.
New legislation is looking to curb the issue of ghost networks. In November, Senators Smith and Ron Wyden (D-Ore.) introduced a new piece of legislation called the Behavioral Health Network and Directory Improvement Act. The bill would focus on strengthening and enforcing directory accuracy standards, holding health plans accountable for specific network accuracy standards while boosting mental health provider network participation.
“By law, insurance companies must cover mental health just like they cover physical health, yet they’re still finding ways to dodge compliance and deny coverage,” Smith said in a statement. “By setting stricter standards and holding insurance companies accountable for inaccurate listings, this legislation will help ensure people can access the mental health care coverage they are entitled to.”
