More than 80 percent of the identified listings for in-network mental health providers under Medicare Advantage (MA) plans were inaccurate or unavailable, according to a secret shopper study conducted ahead of a Senate Finance Committee hearing on ghost networks.
Senate Finance Committee Chair Ron Wyden, D-Ore., called for Congress to take action to get rid of the ghost networks following the release of a secret shopper study conducted by the committee majority staff ahead of a committee hearing on ghost networks.
As part of the study, staff reviewed directories from 12 MA plans in six states, calling 10 systematically selected providers from each plan, for a total of 120 calls. Of the total 120 provider listings contacted by phone, 33 percent were inaccurate, non-working numbers, or unreturned calls. Staff could only make appointments 18 percent of the time.
More than 80 percent of the listed providers staff attempted to contact were ghosts as they were either unreachable, not accepting new patients, or not in-network. In other words, the study found, for every 10 calls where staff attempted to make an appointment to a listed, in-network mental health provider, only two calls resulted in a possible appointment.
The study called for the Centers for Medicare & Medicaid Services (CMS) to increase its oversight efforts to audit health plan directories to ensure they hold MA plans accountable for these directories and for accurately documenting their networks. Congress can also require additional steps to ensure provider directory accuracy including regular audits, transparency, and financial penalties for non-compliance.
“In a moment of national crisis about mental health, with the problem growing exponentially during the pandemic, the widespread existence of ghost networks is unacceptable,” said Wyden in prepared remarks for the committee hearing. “When someone who’s worried about their mental health or the mental health of a loved one finally works up the courage to pick up the phone and try and get help, the last thing they need is a symphony of ‘please hold’ music, non-working numbers, and rejection.”
The MA study echoed the findings of secret shopper studies that looked at commercial health insurance, according to Wyden. In 2017, researchers posing as parents seeking care for a child with depression were only able to obtain an appointment 17 percent of the time. Another from 2015 resulted in an appointment only 26 percent of the time after 360 calls. “It is clear that ghost networks are a persistent, widespread problem in the health care system,” he said.
In testimony before the Senate Finance Committee, Keris Myrick, vice president of partnerships for the nonprofit, Inseparable, said ghost networks and inaccurate provider directors create invisible, unexpected barriers within the health system and prevent people from accessing the care and support they need. “They are particularly damaging for those of us living with serious mental health conditions, like me, as they can result in delayed or inadequate treatment or even going without treatment, any of which can have devastating consequences,” said Myrick, who first experienced ghost networks when she changed her health insurance due to a move and a new job in 2014.
Mary Giliberti, J.D., chief public policy officer, Mental Health America, suggested CMS provide a reward for MA plans that offer accurate directories and networks. MA plans that fail to improve following a correction action plan would be ineligible to participate or lose bonus payments.
Wyden urged eliminating ghost networks via a three-pronged approach: more CMS audits of MA provider directories, greater transparency, and stronger consequences for insurance companies that don’t keep their directories up to date.
Ranking member Michael D. Crapo, R-Idaho, said in prepared remarks for the hearing that it is essential to improve the accuracy of provider directories but cautioned against more regulatory red tape that can add to provider burnout and decrease patient access to care. “Congress should build on the targeted relief measures we advanced last year, including temporary Physician Fee Schedule support and Medicare telehealth expansion, to address these issues on a bipartisan and sustainable basis, � he said.