ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
It’s hard to know if your health insurance plan is as good as advertised. You pay a monthly premium to access a network of health providers. But call the numbers in your provider directory, and you’re bound to find ones who can’t — or won’t — see you.
These errors are at the heart of a ghost network. Some providers have moved, retired or even died; others left insurance networks because of low pay and intense scrutiny. Even though these providers no longer accept your insurance, their names may remain in the directory. When that happens, policyholders are left to believe that the plan has more options than actually exist.
“Any inaccuracy constitutes a ghost network,” said Abigail Burman, a consumer protection attorney who studies provider directory errors. “This is basic information. It needs to be right.”
Insurers’ failures to correct these errors have led to dire consequences for people seeking mental health care, as demonstrated by a recent ProPublica investigation of one man’s months of struggle to access treatment. Because of the widespread nature of ghost networks, some policyholders are more likely to pay out-of-network costs and face a greater chance of treatment delays — if they get treatment at all.
ProPublica spoke with experts, clinicians and advocates to understand the challenges posed by provider directory errors. They all suggested specific ways for policyholders to navigate a ghost network.
How much do insurers know about the errors in their directories? And what are they required to do about it?
Insurers have acknowledged the problem and in some cases have vowed to address it. AHIP, a national association of health insurers, said in a 2023 statement to the U.S. Senate Committee on Finance that insurers update provider directories through “regular phone calls, emails, online reminders, and in-person visits.” However, AHIP wrote that insurers can’t always quickly fix errors because providers sometimes fail to keep their own professional information up to date. (AHIP declined ProPublica’s request for an interview.)
But Dr. Robert Trestman, a Virginia psychiatrist who testified about ghost networks to the same committee, told ProPublica that insurers are able to track “every detail of finance” around things such as billing and coding. Because of that, he said, insurers’ failures “to set up a system for keeping track of who is in network or not is on them.”
But insurers haven’t had to make it a priority. Simon Haeder, a Texas A&M University professor who studies ghost networks, said that insurers have “very little incentive” to closely monitor directories. Unless tougher regulations are passed, he said, policyholders will continue to struggle with directories full of “inconsistent, outdated or incomplete data.”
For years, it has fallen to academic researchers and secret shopper surveys to reveal the pervasiveness of these errors. Lawmakers have passed bills and called for further reforms.