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When I started my training in psychiatry, a senior doctor told me I should have a therapist of my own. He explained that it’s essential to understand myself so I can better understand my patients.

That made sense, so I started calling a list of psychiatrists who supposedly took my insurance. Some of them were dead. Many weren’t taking new patients. Others didn’t take my insurance. I couldn’t find a single psychiatrist on the list to see me. It took months of networking for me to finally find a therapist.

I later found out that my experience was commonplace, possibly deliberate, and that such inaccurate provider lists have a name: ghost networks or phantom networks.

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In a recent study, researchers called 360 psychiatrists on Blue Cross Blue Shield’s in-network provider lists in Houston, Chicago, and Boston. Some of the phone numbers on the list were for McDonald’s locations, others were for jewelry stores. When the researchers actually reached psychiatrists’ offices, many of the doctors didn’t take Blue Cross Blue Shield insurance or weren’t taking new patients. After calling every number twice, the researchers were unable to make appointments with 74% of providers on the list. In a similar study among pediatric psychiatrists, researchers were unable to make appointments with 83% of the providers listed as in-network by Blue Cross Blue Shield.

My patients regularly tell me that this is not unique to Blue Cross Blue Shield and happens with most insurance providers. A 2016 survey by the Centers for Medicare and Medicaid Services showed that it’s also a problem with other medical specialties. The numbers, however, never seem as bad for other specialties as they do for psychiatry.

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Maybe insurance companies don’t know their lists are inaccurate. Maybe they do but choose not to do anything about it. A more alarming possibility is that some companies intentionally keep the lists inaccurate to save money by preventing access to mental health care. After all, ghost networks benefit insurance companies: If it’s hard to find a provider who takes your insurance, it’s less likely you will access services that the insurer will have to pay for.

That concern may be founded, given other recently revealed strategies used by insurance companies to avoid paying for mental health. As Massachusetts state Sen. Cindy Friedman, who has been working to get insurance companies to improve their provider lists, told me, “They’ve known about this for a long time and they haven’t done anything about it. It’s difficult not to assume that this kind of barrier is intentional.”

No matter the reason, ghost networks are unacceptable.

Imagine realizing (or acknowledging) that you have depression — a defining feature of which is loss of motivation — and start looking for a psychiatrist. After calling a McDonald’s, a jewelry store, and providers who say they don’t take your insurance but will be happy to see you for $250 per hour that you must pay out of pocket, you’ll likely be inclined to give up.

Ghost networks are particularly disturbing when it comes to Medicaid plans. States provide insurance companies with contracts to create plans for their poorest citizens. Though many of these companies are nonprofits, they often contract with for-profit companies to administer the mental health benefits. By failing to maintain accurate provider lists, these companies profit from taxpayer dollars while the most vulnerable mental health patients can’t find the care they need.

The outcomes have the potential to be devastating: an individual with severe depression who dies from suicide before he finds treatment, or someone with paranoid psychosis hurting herself because she never received access to effective medication.

Friedman told me a story about a Massachusetts parent who struggled to find an in-network psychiatrist for her son who was hearing voices. Despite calling countless psychiatrists who supposedly took her insurance, she was unable to find one. One day before the 19-year-old got help, the police were called to the home because he locked himself in his room and was yelling. He struck a police office and was arrested.

Insurance companies are finally getting called on the carpet about ghost networks. In California, regulators fined two insurance companies for overstating the breadth of their Obamacare networks in all specialties, not just psychiatry. A 2016 California law now requires Medi-Cal plans to update their online provider directories weekly. Aetna recently settled with the state of Massachusetts after its attorney general launched an investigation into the company’s inaccurate network lists. Massachusetts legislators have introduced “An Act to Increase Consumer Transparency about Provider Networks” that would require insurers to keep updated and accurate lists of in-network providers.

State-level progress is good, but this issue deserves national attention since it affects people across the country in all sociodemographic categories. It also should apply to both private and government-sponsored insurance plans.

Without access to appropriate mental health care, vulnerable people across the U.S. will continue to suffer, and some will die. Every insurance company should be required to keep its provider lists updated so they can’t collect premiums for services they don’t actually provide. Insurers should not profit because they have failed to make mental health care accessible.

Jack Turban, M.D., is a resident physician in psychiatry at Massachusetts General Hospital.

  • This article and the comments reassure me that I am not alone in my frustration and not completely incompetent or a ‘bad’ mother for not being able to help my 16-year old daughter. For months I’ve been looking for an in-network Licensed Marriage and Family Therapist (LMFT) through Blue Cross Blue Shield of Illinois for her as she is really suffering, but can’t make any headway whatsoever.
    Today’s situation involved a therapist who was clearly listed as in-network on the BCBS of Illinois website through my employer’s benefits. The therapist , however, claimed she was not in-network with BCBS of Illinois, so I called BCBS to verify and they insisted that indeed this therapist was contracted as in-network with them. I asked them why the therapist would not know this but they could not answer. They said to have the therapist call the provider line to verify that she is in-network. I asked to get something in writing to prove to the therapist that she is indeed in-network with BCBS of Illinois, but they said she had to call the provider line to verify. When I relayed all this to the therapist she insisted she was not in-network and was not willing to call. She did offer to look at my insurance card, take my daughter’s name and birth date, and look it up in her “system”. After providing all that, she texted me back saying that she looked me up and I (or my daughter’s name) am not in her network. I offered to bring my daughter to a session and if the claim did not go through with BCBS of Illinois, then I would just pay for it myself, but she did not want to do that. I don’t understand why she would allow her name to be listed on an insurance company’s web site clearly marked as “in network” and “accepting new patients”.
    This system is so broken. I wish I knew I what I could do to help fix it. It’s a cause I would gladly volunteer time to change!

  • Great article, and just what I needed in my current state of frustration with this broken system.

    Just curious if anyone has any information about ways to get involved to help address this issue? I’d gladly devote my time and energy to this cause.

  • The state of New Mexico allowed this to go on for years. The insurance companies paid politicians enough money to get them to look the other way. This is just one more way they continue to gaslight the public. In New Mexico, they allowed all kinds of physicians to remain on the lists, to cover for a physician shortage. They also allowed alternative practitioners to advertise as if they were MDs to make it appear there were more doctors. Some of the doctors on the lists were dead for years, had left the state or were too old to practice.

    The insurance companies know exactly who to pay, so they can continue these deceptive practices, and they get help from local media, which depends on their advertising and corrupt politicians.

  • When my old Medicare Advantage plan in OR no longer took individual patients, I had to get a new one for 2019. It took them 4 months to send the list of approved doctors, despite my emails & phone calls several times a month.
    Then they didn’t list the doctors by clinics, just names, so I had no idea how many were colleagues… others didn’t accept new patients or those over 65 years…
    So I got an old doctor to extend my prescriptions for a couple of times under emergency renewals & did without them for much of the year. Now in 2020, I have found another plan that other friends use, so I am reassured that they are in business to treat patients, not pay out CEO bonuses!
    Local health depts didn’t know where I could complain to about this lack of service. But the medical insurance company sure wanted its monthly premiums, despite lack of service!!
    ‘Tis said that satisfied customers recommend providers to 5-8 friends, but dissatisfied ones spread their ire to 20-30 acquaintances…
    Big Pharm, beware!!

  • Very interesting and informative article. You are considering a very important problem that worries a large number of people. In fact, when there is no way to get the necessary help, depression increases at a critical rate. Nowadays, when the schedule of every person on earth is so busy that sometimes there is no time to drink a cup of coffee, when the number of daily tasks exceeds human capabilities, and when there is not enough time for anything at all, mental health is at great risk. That is why we need specialists and the ability to contact them. This article describes in great detail where you can find a qualified specialist, how to contact him etc.: https://www.depressionalliance.org/psychiatrist-near-me/

    • Thanks! You are right, the speed of life has become very high and it is difficult to withstand. I am looking for a psychiatrist online and free because I do not have money and insurance to pay a doctor. Do you have experience consulting online? I want to try this method, I hope it is effective

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