Big Insurance likes ghosts. Patients need real care.
Halloween ghosts disappear when the decorations come down. A health plan’s “ghost network” can leave patients chasing care long after October ends. The premium is real. The promised access should be, too.
A provider directory is part of an insurer’s promise to its members. When a listed clinician cannot be reached, no longer participates or cannot accept a patient, a long list of names can offer far less access than it appears to provide.
The pressure to get directories right is growing
In new reporting from Becker’s Payer Issues, Elizabeth Casolo describes lawsuits over directory accuracy and renewed efforts to address the problem. The lawsuits contain allegations, not findings of liability. But the underlying question deserves a direct answer: can members actually use the network they are paying for?
On October 16, CMS proposed new Medicare Advantage directory requirements. Plans would verify and update information at least every 90 days, report accuracy scores and display those scores publicly. The proposal also would protect members from higher out-of-network cost sharing when they obtain care after relying on an inaccurate directory listing.
These are proposed rules, not protections newly in force. CMS describes them as changes for contract year 2028. They are a step toward accountability, but patients need usable networks today.
A directory is not an appointment
Our recent appointment-access analysis examined a JAMA Health Forum study of mental-health directories across six Blue Cross Blue Shield licensees in five states. Just 12.4% of 5,822 initial secret-shopper calls secured an appointment. Many calls could not be evaluated, often because they reached voicemail; the adjusted appointment rate among evaluable calls was 32.1%. These are appointment-access measures, not claims-denial rates.
The practical point is straightforward: listing a clinician is not the same as delivering a path to care.
What accountability should look like
Verify the promise. Test whether listed clinicians can actually be reached and whether participation and availability information is accurate.
Show the results. Give members clear, comparable information about directory reliability and the ability to obtain appointments.
Fix the failure. Correct bad listings promptly and help members find care when the advertised network falls short.
Protect the patient. Members should not carry the financial burden of an insurer’s inaccurate information.
Ghost networks concern access to listed providers. The payment-benchmark problems examined in our No Surprises Act audit coverage are a separate issue. Both deserve scrutiny, without confusing the evidence.
Paying for coverage should buy more than a directory full of possibilities. It should buy a dependable way to get care.
Have a documented directory problem or difficulty finding an in-network provider? Tell Big Insurance Watch.