You Pay the Full Premium. Getting an Appointment Shouldn’t Be a Long Shot.

Just 12.4% of initial calls secured a mental-health appointment in a five-state study of Blue Cross Blue Shield directories.

Paying for coverage should mean having a practical path to care. A directory full of names is no substitute for an appointment patients can actually book. New research puts that gap in focus.

What the study found

Researchers made 5,822 secret-shopper calls to psychiatrists and psychologists listed by six Blue Cross Blue Shield licensees across Delaware, Montana, New Jersey, Rhode Island and Virginia. Calls took place between October 2025 and March 2026. The study was published in JAMA Health Forum on October 16, 2026.

Across all initial attempts, 12.4% yielded an appointment with any clinician. Among calls with a definitive outcome, 55.6% encountered directory inaccuracies and 21.6% encountered capacity limitations.

Coverage should open doors

Insurance is sold as a promise of access. When patients must work through inaccurate listings, unanswered calls and closed panels, the burden of making that promise work falls on the people who already paid for it.

For someone seeking mental-health support, every extra call is another task between asking for help and receiving it. Network adequacy should be demonstrated through usable appointments, not simply the length of a provider list.

Big Insurance Watch believes insurers should publish independently checked directory accuracy, appointment availability and wait times. Employers buying coverage should demand those measures. Regulators should test whether advertised networks work for patients in practice.

Collecting premiums comes with a responsibility to deliver meaningful access. Patients deserve evidence that the network they are paying for is a network they can use.

Understanding the number

The 12.4% figure measures initial call attempts, not the share of covered care delivered or claims denied. Most calls (61.3%) had no definitive outcome, often reaching voicemail or automated systems. The study does not establish whether later attempts secured care. Among evaluable calls, the adjusted appointment rate with any clinician was 32.1%. Findings concern the plans and specialties studied, not every insurer or service.

Sources

Read the original JAMA Health Forum study →
Mental Health Ghost Networks in Commercial Insurance Plans · October 16, 2026

Read Becker’s reporting →
12% of calls to mental health clinicians in Blue Cross directories yield appointments: Study · October 19, 2026

BIW analysis. Research findings are attributed above; the accountability recommendations are Big Insurance Watch’s position.