Insurance Ghost Networks Delay Access to In-Network Care and Raise Costs

The phenomenon of "ghost networks" in health insurance provider directories is complicating patient access to in-network care, particularly in specialized fields like autism therapy and mental health services. These ghost networks consist of outdated or inaccurate provider listings that are either unreachable, no longer accepting new patients, or out of network, leading to significant delays and increased out-of-pocket costs for patients.

Parents like Michelle Mazzola have encountered these challenges firsthand while seeking therapy for their children with autism, despite relying on insurance directories for in-network providers. Legal actions, such as class action lawsuits against insurers like Anthem Blue Cross Blue Shield and Carelon Behavioral Health, claim these networks mislead consumers and increase their financial burden by forcing out-of-network care.

Regulatory frameworks including the No Surprises Act impose requirements on insurers to update directories every 90 days and reimburse out-of-network costs arising from inaccurate listings, yet enforcement and penalties remain limited and inconsistent. Industry experts highlight the complexity of maintaining accurate provider data, often due to inconsistent provider reporting focused on billing rather than patient accessibility, and the challenge insurers face in verifying this information.

Data-driven solutions such as AI-assisted directory management are proposed as innovations to improve data accuracy. Despite these efforts, patients continue to experience frustration and barriers to timely care, underscoring the need for improved regulatory oversight and potentially centralized provider directories to mitigate ghost networks. Stakeholders acknowledge the difficulty of balancing provider availability, network adequacy standards, and operational challenges in network management, emphasizing ongoing industry and regulatory efforts to address the issue.