Inaccurate health plan directories, also known as ghost networks, can block patients from much-needed behavioral health care, drive up health care prices and keep providers from reaching potential clients.
Regulations like the No Surprises Act that mandate more accurate health plan directories have largely failed, according to a new study published in BMC Health Services Research.
These inaccuracies compound existing barriers to behavioral health care, according to the study’s primary author, Neel Butala, who serves as the chief medical officer at AI company HiLabs.
“It is often challenging for patients to realize they have a behavioral health need and seek care,” Butala told Behavioral Health Business in an email. “Once patients make the decision to seek care, they often run into barriers to make an appointment due to inaccurate provider directories. As we find in this study, contact information for providers is frequently incorrect, so it takes a lot of time and effort to find the right provider that actually practices at the location listed.”
The study examined publicly available health insurer provider directories of five national health plans: UnitedHealth, Elevance, Cigna, Aetna and Humana. Researchers analyzed over 440,000 provider listings from 2022 to assess the accuracy of each insurer’s network information.
Of mental care providers, including psychiatry and neurology clinicians, only 16% had correctly listed phone numbers and only 28% had correct addresses.
The results varied by provider specialty, but there was minimal variability across different insurance plans. Existing regulations did not significantly improve provider directory inaccuracies, which the authors attribute to inconsistent or minimal enforcement.
“The low variation in physician data consistency by insurer is suggestive of the systemic nature of the provider data quality problem across insurers, irrespective of individual insurer processes,” the study’s authors wrote.
Researchers conducted this study as a follow-up to their 2023 research, which found inconsistencies in 81% of physician listings in health plan directories.
The new study sought to determine if provider inaccuracies were isolated to a single health plan, state, or physician specialty.
“Unfortunately, no insurer seemed to have solved this problem and state-level regulations or enforcement of regulations did not correlate with the degree of inaccuracy,” Butala said. “Although directory accuracy was poor across all physician specialties, it was interesting to see how more patient-facing specialties, such as dermatology or plastic surgery, which may get direct referrals via provider directories, had higher levels of accuracy compared to those that did not directly see patients.”
Legislators have taken action to reduce inaccuracies in ghost networks since the data from this study was collected.
For example, senators introduced the Behavioral Health Network and Directory Improvement Act earlier this year. If passed, the bill would require the federal government to independently audit health plans’ provider networks.
In 2023, lawmakers introduced the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, which was designed to strengthen requirements for Medicare Advantage plans to maintain accurate provider directories and protect seniors from inaccuracies.
For Butala, the “ideal” way to improve ghost networks would be to create an industry standard for provider data, similar to the existing standards for billing processes with claims data. But implementation would be difficult, he said, since it would require alignment across many stakeholders and could lead to technical and operational issues.
“A more pragmatic solution would be for more entities to use technology solutions, similar to what we used in this study to identify inaccuracies, to proactively identify directory issues, automate more of this manual work, and improve directory accuracy overall,” Butala said.
New legislation may be more successful if it incorporates provider groups, the study’s authors wrote.
