Going to the doctor is typically not all that much fun. What’s even less fun, though, is actually finding a doctor. First, you have to actually find the doctor—depending on whether you need to see a specialist or not, this can become complicated. Next, you’ll need to find out if the doctor you’ve found is actually in your insurance’s network. Luckily, most insurance companies have a tool that lets you search for in-network providers. But then the challenge becomes finding one that isn’t going to schedule your appointment for six months out. At this point, it might be faster to go to medical school and become a doctor yourself.
In addition to the difficulties mentioned above, there’s one other thing that might make finding a provider even more difficult: ghost networks. Here at Payday HCM, we’ve had many potential clients come up to us complaining about this issue. It’s something that’s unfortunately more prevalent than it should be and can create a lot of confusion for everyone involved.
But, what actually is a ghost network? Well, in this article, we’ll go over what exactly a ghost network is. We’ll go in-depth with the different traits and things that make up a ghost network and why exactly they can potentially be harmful. Then, we’ll go into some tips on how to spot ghost networks so that you and your team no longer have to be afraid of these ghoulish networks.
In this article, you will learn:
What Is A Ghost Network?
Firstly, we need to establish what exactly a ghost network is. It’s important to know what exactly they are in order to better understand why they can be harmful.
Not All Providers Are As They Seem
A ghost network is a term used to describe providers listed in an insurance network that, for one reason or another, aren’t actually available. The reasons for these providers not actually being available can range anywhere from someone retiring to the provider leaving the network due to low pay. Regardless, the provider is no longer in-network but is still listed under the insurance’s in-network providers.
Thus, when someone goes to look for an in-network provider, they may find themselves stumbling on these ghost networks. The term “network” is used here and not “provider” in order to convey the number of these invisible providers that may exist within any given insurance provider’s network.
They are so prevalent, in fact, that the national association known as America’s Health Insurance Providers spoke to the Senate Finance Committee about insurance companies working to address the issue.
Why Do Ghost Networks Exist?
As mentioned above, ghost networks exist due to the discrepancy between a provider choosing to leave an insurance network and that insurance company going in and updating their in-network provider list.
During the same session when AHIP spoke to the Senate Finance Committee, they explained that updating these lists can sometimes be made difficult due to inaccurate information from the providers. Providers, though, have also been tasked with fixing the errors in these networks. A study performed by the Council for Affordable Quality Healthcare found that providers spend around $2 billion nationwide just to keep directory information up to date.
Ultimately, it’s an issue that many have been trying to solve, but it continues to be pervasive to this day. According to The Hill, many have called on Congress to help get the issue under control.
What Are The Dangers Of Ghost Networks?
Now that we understand a bit better as to what ghost networks actually are, we can dive deeper into why these false entries in an insurance provider’s network pose such a threat.
Access To Mental Health Care
One of the biggest issues with ghost networks is how they threaten to limit quick access to mental health care. A “secret shopper” audit performed by the Senate Finance Committee had an 18 percent success rate in making an appointment with a mental health care provider from 12 different health plans.
According to Axios, therapists and counselors opt out of insurance networks more often when compared to other providers due to insurers having the final say in who is allowed to receive care and for how long.
On top of all of this, the Seattle Times performed a secret shopper study where they called 400 therapists in the Seattle area and only received 32 responses—about 8 percent.
The Cost Of Ghost Networks
As mentioned above, these ghost networks can prove costly for providers looking to limit their presence. That same survey found that providers will generally spend around $998 a month to have a full-time staff member who can ensure provider information is accurate.
Ghost networks can also increase the amount people pay in out-of-network costs, as the lack of actual in-network providers will lead others to seek out-of-network care with reimbursement. According to Mental Health America, though, reimbursement rates for mental health providers are often lower than other providers.
How To Identify A Ghost Network
Until a solution is found to truly crack down on ghost networks, it’ll be up to the users to identify and avoid them. Luckily, there are a couple ways you can identify them.
Do Your Homework
Before you actually acquire a plan, the best thing you can do is to check out that provider’s network and ensure there are providers that, for one, exist and are in-network that you would have access to. You’ll want to verify that the information provided about any given provider is accurate and then reach out to the provider to confirm they are still in-network.
According to NPR, if you’re already in a plan, the best thing you can do is to obtain a copy of your “Evidence of Coverage.” This document explains the contractual obligations that your insurer has to you in terms of finding you a provider. In some cases, they may be obligated to find you an out-of-network provider if there isn’t an in-network provider available.
How To Combat Ghost Networks In Your Insurance Network
If you’re already with a specific insurance provider and have found yourself dealing with ghost networks, there are a few different things you can do to help combat them. As mentioned above, ensuring you know what your insurer is required to do for you as outlined in the Evidence of Coverage document is a great first step.
If you’ve been struggling to find a provider, calling your insurance provider and asking them to find you an appointment can also be a helpful strategy. Make sure you note the representative that you’re speaking to in case something goes wrong.
And if this still doesn’t work, you’ll want to reach out to the government agency that’s in charge of regulating your insurance provider and get in touch with your regulator. This will allow you to submit a complaint with the regulator.
The Frightening Reality Of Ghost Networks
It’s no secret that finding an in-network provider with appointment availability is a difficult task. In a post-pandemic world, it seems like you’re lucky if you’re able to book something that’s only one month out instead of six. With all of these different factors affecting your ability to find and see a provider, ghost networks only add to the difficulty. Now you’re making ten, twenty calls a day just to find someone to see. Hopefully, now that you have read this article, you’ll feel a bit less scared about making that next appointment.
As mentioned above, ghost networks can have a particularly acute effect on those seeking mental health care. For someone looking to ensure their employees are taken care of, this can be especially concerning. Find out more about the role employee benefits play in ensuring your team’s mental health is taken care of.
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