Almost half of Medicare Advantage online provider directories have at least one inaccuracy – with issues often related to behavioral health services. A new bipartisan bill would protect seniors from the consequences of these inaccuracies, if passed.
And by doing so, the bill could also lead to MA plans strengthening their provider networks, which could mean more business opportunities for behavioral health providers.
Online provider lists that include providers who are no longer in-network, accepting patients or have closed their practice are known as “ghost networks.” The new bipartisan bill, introduced by Senators Michael Bennet (D-Colo.), Thom Tillis (R-N.C.) and Ron Wyden (D-Ore.), would work to ensure that MA plans maintain accurate directories and protect patients from costs associated with such ghost networks.
The number of ghost providers on online networks can be extensive. One study, for example, found that more than half of all mental health providers listed on Oregon Medicaid managed care providers’ networks did not actually see patients.
The new bill – the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act – would strengthen requirements for MA plans to maintain accurate and updated provider directories and require the U.S. Centers for Medicare & Medicaid Services (CMS) to publish guidance for plans on how to maintain accurate provider directories, beginning in 2026.
“Too often, seniors and families get health care whiplash when they sign up for a plan only to find out that their preferred doctor is out-of-network, or it’s impossible to find a covered mental health care provider,” Wyden said in a press release. “This bipartisan legislation is a big step towards holding insurance companies accountable so their provider directories are accurate, and I’ll be working hard to get it passed.”
Incorrect information in provider directories wastes money as well as time. Another study found that patients who encountered inaccuracies in provider directories were 4 times more likely to receive a surprise outpatient out-of-network bill.
The bill aims to prevent patients from being stuck with out-of-network bills that were listed as in-network.
“The federal government pays Medicare Advantage plans to provide timely services, but their inaccurate provider directories lead to frustration, financial hardship, delay, and denial of care,” Mary Giliberti, chief public policy officer for Mental Health America (MHA), said in a press release. “MHA supports this bill as an important step forward in addressing this persistent problem that causes so much harm to people with mental health and substance use conditions and their families.”
Ghost networks came under fire earlier this year when health care advocates and providers pleaded their case to the Senate Finance Committee. The committee did not take action, but discussed the importance of ghost network reform.
The REAL Health Providers Act will be on the legislative agenda this year or early next, though many health care-related initiatives have been derailed due to turbulence related to the federal budgetary process.
The bill was officially introduced on Oct. 17 and referred to the Committee on Finance.