The phrase “ghost network” describes a health insurance directory that includes multiple providers who cannot meet the needs of the patients they claim to serve.
In some cases, the providers listed on the directory are out of network, even though they are listed on an in-network directory. In others, the doctors listed are not accepting new patients. Often, the contact information is entirely wrong, and patients find themselves talking to a McDonald’s or Starbucks instead of a provider’s office.
The Consequences of Ghost Networks for Providers and Patients
Ghost networks hurt everyone involved in the system. Patients are frustrated that they can’t get the care they need. Providers miss out on getting new patients and may choose to drop a network that isn’t helping them reach the patients they want to serve. Payers lose out on money from those patients who switch insurance carriers when they can’t find the providers they need.
Ghost networks are not necessarily formed intentionally. Instead, they can evolve from the simple truth that it is challenging to keep up with the always-changing field of healthcare. Managing multiple directories to ensure every provider’s information is accurate is no small feat.
Nonetheless, the consequences of consistently posting inaccurate information on healthcare directories can lead to litigation. For example, in 2021, the city of San Diego announced its plans to sue several insurers for misleading consumers with ghost networks, which are illegal in California.
While ghost networks can impact every field of healthcare, mental health providers seem to have the most significant challenges. A recent study took a “secret shopper” approach to book an appointment with a psychiatrist in three major cities. Only 26 percent of providers scheduled appointments after two rounds of calling. Forty percent of calls were answered, although 16 percent of the numbers listed in the directory were wrong.
Some reasons psychiatrist offices gave for not being able to schedule an appointment included:
- Not accepting general adult outpatients
- Not accepting payment type
- Not accepting new patients
- Needing more information before making a decision
- Being out of the office
This small study highlights the issues with ghost networks on payer websites. When the information is incorrect, patients struggle to get in touch with a provider to give them the help and care they need. As a result, they might give up and decide not to seek timely care that could escalate into a medical emergency later.
Fortunately, there is a way to mitigate your risk of forming a ghost network to improve the process for everyone.
See How HealthLink Dimensions Can Improve Provider Databases
HealthLink Dimensions is the authority on healthcare provider data. We believe that life sciences organizations, hospitals, and health insurance companies should all expect more from their healthcare provider database solution. That’s why we deliver incomparable accuracy, unparalleled value, and exceptional service.
Our solutions include Provider 411, Provider Directory Advantage, and Network Adequacy including compliance support for the new directory requirements in the No Surprises Act. They are designed to help health insurance companies quickly identify gaps and inaccuracies in their directories, source new providers to augment their networks, and ensure they meet state and federal network requirements.
If you’re looking for a better way to manage your healthcare provider data, contact us to see how HealthLink Dimensions can improve your provider data management.