Understanding and avoiding “ghost networks”

Directories help potential clients find your practice, but when insurance directories list you as part of a network you’ve never agreed to (or exclude you without explanation), administrative headaches and client frustration can derail access to care. These phantom listings, known as ghost networks, are a growing problem in healthcare. This article will help you understand what ghost networks are, what to do if you find your practice listed in one, and practical steps for avoiding them. 

What exactly are “ghost networks”?

Ghost networks are inaccurate or outdated provider directories used by insurance companies. They often include providers that: 

• Are not accepting new patients 

• Are no longer practicing or are deceased 

• Have incorrect contact information 

• Are listed for locations where they don’t actually see clients 

• Are no longer in-network with that specific plan 

It’s not uncommon for therapists to be falsely listed as “in-network” when they’ve never contracted with the insurer. Other times, they can omit you from the network you’re paneled with without notice, leaving clients confused and claims denied. Some of them display outdated credentials, such as old office locations or expired certifications. In “secret shopper” studies, Senate Finance Committee staffers and the Seattle Times found that more than 80% of providers listed were “ghosts” that either could not be reached, didn’t accept new clients, or weren’t in network.

Why do they exist?

Often, insurance companies are required by law to maintain “adequate” networks of providers. Listing a high number of therapists, even if many are unavailable, allows them to appear compliant on paper, without necessarily ensuring actual access to care. This creates a disconnect between what the directory promises and what clients can actually find. And unfortunately, enforcement of these penalties is very lax; ProPublica found that “most states haven’t fined a single company for publishing directory errors since 2019”.  That means there’s little incentive to change.

The harm ghost networks can cause therapists (and your clients)

Imagine a client searching for an in-network therapist, diligently sifting through their insurance company’s online directory. They find your name, call your office, only to learn you’re not accepting new clients, your contact information is wrong, or perhaps you’ve even retired from that particular network. This frustrating experience is the hallmark of a “ghost network.” It’s not your fault that your practice’s name is associated with inaccurate listings, but that frustration can be directed at your office regardless. 

Ghost networks also waste time. You, or your staff spend precious time fielding calls from misdirected clients with outdated information, taking away from actual client care or practice management. And clients spend hours calling practices and trying to get information, leading to more frustration, dead ends and delays in care. They may even get deterred entirely from seeking help. 

There are also monetary consequences. Clients submit insurance information based on outdated directories, leading to surprise bills and broken trust. Hours may be spent disputing errors with insurers or re-filing claims. You may also get negative reviews or complaints if clients feel misled by insurance issues. And unfortunately, clients may abandon therapy if costs suddenly become out-of-pocket rather than covered by insurance. 

This is particularly frustrating for therapists who make an effort to keep their information up-to-date. Imagine desperately looking to fill your caseload knowing potential clients either don’t see your information or get directed to the wrong practice. It’s disheartening, and you’re not paid for that labor. 

More broadly, despite laws like the Mental Health Parity and Addiction Equity Act (MHPAEA) aimed at ensuring equal access to mental and physical health benefits, ghost networks actively undermine this goal. 

How to avoid being listed in a ghost network 

Prevention is key. Taking proactive steps can significantly reduce the chances of your practice being mis-listed. 

First, proactively manage the directories in which you’re listed. Don’t just set it and forget it. Integrate regular directory checks into your practice’s administrative routine. Consider a simple spreadsheet with reminders to check and update your listings. 

When you join new insurance panels or you update your status, ask the payer about their specific process for updating their provider directory. Understand how frequently they verify information and what steps you need to take to ensure accuracy. 

If you decide to leave an insurance network, follow up diligently to ensure your name is completely removed from their provider directories. Don’t assume it will happen automatically. Get confirmation in writing if possible. 

If an insurer lists you without a contract, send a formal opt-out notice. 

Consider having a page on your website that lists all the payers you work with. It can help potential clients decide if your practice will take their insurance. And if they notice a discrepancy, they might be more likely to check. Share steps clients can take to confirm benefits (e.g., calling their insurer’s member services). 

Lastly, always check eligibility before appointments to avoid surprise bills. 

Steps to take if you’re caught in a ghost network 

It’s common for therapists to find their practice inaccurately listed. If you discover you’re part of a ghost network, here are steps you can take: 

1. Contact the insurance company directly

• Reach out to their provider relations department. This is usually the correct channel for directory updates. 

• Be specific: Clearly state what information is incorrect and what it should be. 

• Document everything. Keep a detailed record of your calls: dates, times, the name of the representative you spoke with, what you discussed, and any reference numbers provided. If you communicate via email, save those records. This documentation is crucial if you need to escalate the issue. 

• Follow up. If changes aren’t made within a reasonable timeframe (e.g., 2-4 weeks), call again, referencing your previous contact. 

2. File a formal complaint

If repeated attempts with the insurance company don’t yield results, escalate the issue to: 

• State Department of Insurance (DOI) or Attorney General: These agencies regulate insurance practices within your state. Many have online portals for filing consumer or provider complaints related to network adequacy or inaccurate directories. 

• Federal agencies: For certain employer-sponsored plans (ERISA plans), you might file a complaint with the U.S. Department of Labor. For other issues, the Department of Health and Human Services (HHS) might be relevant. 

3. Advocate for change

Share your experiences with professional organizations (e.g., your state psychological association, national mental health associations). They can use this anecdotal evidence to advocate for stricter enforcement and better regulations on network adequacy and directory accuracy. 

Systemic changes are needed 

Ghost networks persist because insurers often prioritize profit over accuracy. Advocates argue for mandatory audits with regular checks of directories by state regulators, centralized platforms where therapists can update their status in real time, and fines insurers for outdated or false listings. 

Until then, vigilance is your best tool. By staying informed and proactive, you can protect your practice, and ensure your clients receive the care they deserve, without surprises.