Mental Health Ghost Networks: Study Finds Few Calls Lead to Appointments

Less than a quarter of calls to mental health providers in commercial insurers’ networks ended with a scheduled appointment, a secret shopper study from Ohio State University researchers found. The study adds to evidence of ghost networks, where insurers list providers as in-network but patients can’t reach them or get seen. About 60% of the more than 5,800 calls went unanswered, which points to mental health ghost networks as a real barrier to care.

Published in JAMA Health Forum, the study had researchers pose as a patient on a standard PPO plan and call the closest listed psychiatrist or psychologist in the directories of the largest commercial insurers in Delaware, Montana, New Jersey, Rhode Island and Virginia. 

Among calls that were picked up or disconnected, 56% exposed errors in provider directories. About 22% revealed specialty errors, and 11% reached disconnected or out-of-service numbers. Another 1.6% showed network status errors, such as a clinician no longer in the network. One in five usable calls hit capacity limits, with clinicians not taking new patients or having no openings, even when the listing was right.

A correct listing doesn’t guarantee care, which makes mental health ghost networks harder to fix than a wrong phone number. Laws such as the No Surprises Act already require accurate provider directories, yet the researchers say access hasn’t improved because the rules track the wrong metrics and miss other barriers. Psychologists often work alone in small offices with little staff to answer phones, which adds to the problem. The HHS Office of the Inspector General found that 28% of listed behavioral health clinicians in Medicaid directories were unreachable or inactive. This secret shopper study covered only five states, so treat the figures as a sample, not a national count.

CMS has proposed a rule to clean up provider directories in Medicare Advantage. It also wants a centralised national directory as a single source of provider and facility information, fed by new Medicare Advantage data. Watch whether the rule goes beyond listing errors to unanswered calls and capacity limits, since the study ties mental health ghost networks to all three.