Inaccurate provider directories, known as “ghost networks,” can land patients with shocking bills and cause providers to miss out on potential patients. Ghost networks have increasingly come under fire by policymakers aiming to hold health plans accountable and protect patients.
A new bill, introduced last week by U.S. Senators Tina Smith (D-Minnesota) and Ron Wyden (D-Oregon), would crack down on health plans with inaccurate provider directories and seek to increase behavioral health providers’ in-network participation.
Called the Behavioral Health Network and Directory Improvement Act, the bill would require the federal government, as well as health plans, to conduct independent audits to determine the accuracy of health plans’ provider networks. This information would be posted publicly online, and if health plans fail to comply with network and directory adequacy requirements, they would be subject to civil monetary penalties (CMPs) issued by the Department of Labor.
“In the worst cases these ghost networks are essentially a fraudulent product, but health insurance companies continue to sell those policies for top dollar,” Wyden said in a statement. “Amid a nationwide mental health crisis, it’s outrageous how common it is for people in need of treatment to find that their health insurance is almost useless when they try to see a mental health provider.”
Health plans will be held to a higher network adequacy standard if the bill passes. Insurers would be required to consider the ratios of behavioral health providers to patients enrolled as well as waiting times for appointments, geographic accessibility of providers and the network’s ability to meet patients’ needs.
A summary of the bill called the Behavioral Health Network and Directory Improvement Act said that mental health professionals frequently leave health plan networks because of low reimbursement rates and insufficient network adequacy standards. The legislation aims to increase the number of in-network behavioral health providers by requiring federal agencies to establish parity standards to keep behavioral health reimbursements on par with physical health.
“By law, insurance companies should cover mental health just like they cover physical health, yet they’re still finding ways to dodge compliance and deny coverage to customers,” Smith said in a statement.
The legislation cracks down on health plans and requires additional work from providers. If passed, behavioral health providers must regularly update the information they submit to health plans, including timely information on whether they are currently accepting new clients.
The bill would provide consumers with additional protection by establishing state and tribal programs designed to educate people on their rights under the mental health parity law. It would also require health plans that maintain ghost networks to inform enrollees that they may be eligible for a refund if they see a provider who was inaccurately listed as in-network.
Ghost networks have previously been a target for legislators.
Another bill designed to combat ghost networks, the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, was introduced to the Senate in October 2023 and was referred to the Committee on Finance. The REAL Health Providers Act would help protect seniors from the problems associated with ghost networks by ensuring Medicare Advantage online provider directories stay up-to-date.
The Behavioral Health Network and Directory Improvement Act has been endorsed by the National Alliance on Mental Illness (NAMI), The Kennedy Forum and the National Council for Mental Wellbeing, among other organizations.
