Medicare Advantage Riddled With Ghost Networks

Senate Finance Committee finds mental health provider directories are widely inaccurate in the private program.

Ghost networks, or inaccurate provider directories, are a widespread problem for mental healthcare within Medicare Advantage (MA), according to a survey by the Senate Finance Committee.

A secret shopper study was conducted by the committee majority staff, who reviewed directories from 12 MA plans in six states to uncover the extent the mental health provider ghost networks.

Staff called 10 providers from each plan with the aim of obtaining an appointment for an older adult family member with depression. Of the 120 total listings contacted, 33% were found to be inaccurate, non-working numbers, or unreturned calls. Appointments could only be made 18% of the time and rates varied by plan and state, from 0% in Oregon to 50% in Colorado.

Overall, more than 80% of mental health providers staff attempted to contact were deemed ghost networks for being either unreachable, not accepting new patients or not in-network.

On multiple occasions, the number listed was for a different entity. In six instances, calls were routed to a national third-party provider matching service that asked for additional information about the patient's health needs and insurance information before setting an appointment. The study considered these calls as successful appointments under the assumption that an appointment would be made if the information was submitted.

Further, the time it took staff to reach providers varied across plans, ranging from one to three hours to contact 10 listings per claim. When staff were able to make appointments, some were offered within a month while several providers offered months in the future, including one instance in which the earliest appointment available was in 10 months.

"In a moment of national crisis about mental health, with the problem growing exponentially during the pandemic, the widespread existence of ghost networks is unacceptable," Senate Finance Committee chair Ron Wyden (D-Ore.) said. "When someone who's worried about their mental health or the mental health of a loved one finally works up the courage to pick up the phone and try and get help, the last thing they need is a symphony of 'please hold' music, non-working numbers, and rejection."

To combat ghost networks, Wyden stated that it will require a three-pronged approach of more audits, greater transparency, and stronger consequences for insurers with inaccurate directories. The report concludes by suggesting that Congress can hand out financial penalties for non-compliance.