Healthcare experts demand uniform provider directories.

Do you know what ghost networks are? They are formed when a health insurance plan’s directory includes inaccurate information, such as listings for doctors who have retired, never worked for the listed office, or are outside the plan’s network. This causes stress, unnecessary expense, and aggravation for insurance customers every day, according to witnesses testifying before a Senate Committee on Finance hearing on May 3.

Standardization and Accountability

Witnesses called on Congress to take steps to standardize directories and hold insurance companies accountable for the issue. Dr. Jack Resneck, president of the American Medical Association, said it affects the entire health care industry and requires government intervention. Achieving directory accuracy is not simple, he said, as each plan has its own system for updating directory information. A strong regulatory system would restore consumer confidence in a health care system that can’t help them find a doctor.

Personal Experience

Keris Jan Myrick, vice president of partnerships for Inseparable, an organization that advocates for improving mental health care policy, told the committee that she has personal experience with the frustration that a ghost network can provoke. When she moved from Los Angeles to Washington, Myrick consulted her health plan’s directory to find a new psychiatrist. She described the experience as searching for a needle in a haystack. Myrick, who requires treatment for schizophrenia, said that when she finally found a psychiatrist in Washington who was taking new patients, she was told that the doctor didn’t treat schizophrenia. She was forced to make monthly trips back to Los Angeles to continue seeing her original doctor. Myrick told the committee that people with her illness but without resources could expect to deal with homelessness, the criminal courts, and other problems. The consequences are dire, she said.

Government Intervention is Needed

Dr. Robert Trestman, of the Carilion Clinic and Virginia Tech Carilion School of Medicine in Roanoke, Virginia, agreed. As chair of psychiatry and behavioral medicine, he serves a largely rural area, so finding a doctor can already be a challenge. Dealing with a ghost network can be especially difficult for someone with a mental illness. Enough is enough. We can fix this, he said.

Conclusion

Chairman Ron Wyden (D-Ore.) said that inaccurate health care provider directories are an ongoing, persistent problem. His staff did a “secret shopper” survey of health plans and successfully booked an appointment 18 percent of the time. Wyden said this often becomes apparent only after a customer has enrolled in the plan. In his view, it’s a breach of contract. The last thing customers need from an insurance company is a symphony of ‘please hold’ music.