Having health insurance and actually seeing a psychiatrist or psychologist turn out to be two very different things. When researchers posing as patients called mental health clinicians listed as in-network by major commercial insurers, fewer than one in four of the calls that reached a person ended with an appointment.
The secret shopper study, published Friday in JAMA Health Forum by researchers at Ohio State University and Stanford University, is one of the largest tests yet of so-called ghost networks: provider lists that look full on an insurer’s website but lead patients to wrong numbers, retired clinicians and practices that are not taking new patients.
Callers placed 5,822 calls between October 2025 and March 2026. Among the 2,252 calls that reached a human and could be evaluated, 23.6% produced a scheduled appointment. That rose to 31.1% when the caller agreed to see a different clinician at the same practice.
“This shows that even those with private insurance, who are told they have many providers to choose from, can have a hard time getting the care they need,” said Simon Haeder, an associate professor at Ohio State’s College of Public Health who led the study with professor Wendy Xu.
What is a ghost network in health insurance?
A ghost network is a provider directory that overstates how much care is really available. Clinicians stay listed after they move, change phone numbers, leave a practice or stop seeing new patients. Insurers may also list every clinician in a contracted group even when some of them are not actually available to plan members.
“Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes aren’t always reflected in insurance directories,” Haeder said.
Xu put the cost in plainer terms. “Inaccurate provider directories are not simply an administrative inconvenience,” she said. “They can create substantial barriers to care, leaving people effectively underinsured despite having insurance.”
How did researchers test mental health provider directories?
The callers posed as adults with nonemergency concerns such as anxiety and grief, enrolled in a PPO plan from the largest commercial insurer in each of five states. Those carriers were Blue Cross Blue Shield of Rhode Island, Blue Cross and Blue Shield of Montana, CareFirst BlueCross BlueShield in Virginia, Highmark Blue Cross Blue Shield Delaware and Horizon Blue Cross Blue Shield of New Jersey. For each simulated patient, they tried to reach the nearest psychiatrist or psychologist in the plan’s online directory.
More than six in ten calls could not be evaluated at all, because they reached an answering machine or an automated system with no way to talk to staff.
Why couldn’t patients get mental health appointments?
Bad directory data was the biggest reason. Of the 2,252 evaluated calls, 55.6% turned up inaccurate information in the insurer’s directory, most often wrong contact details. That included 11.4% of calls that reached a disconnected or out-of-service number. Another 22% failed because the clinician had no room, including providers not accepting new patients.
Success rates ranged from 18% in Virginia to 32.9% in New Jersey, and were similar for psychiatry and psychology. Rural clinicians were more likely to offer an appointment than those in cities and suburbs, though rural patients faced longer drives: 30.8 minutes on average, against 17.1 minutes overall.
Even a successful call meant a wait. Patients who booked were told the average wait was 20.5 days, and longer for psychiatry than psychology.
The authors noted the findings come more than three years after the No Surprises Act’s directory accuracy requirements took effect, a sign that existing rules are “insufficient or lack meaningful enforcement mechanisms.” The study was funded by Inseparable, a national mental health advocacy group.
What is the government doing about ghost networks?
For people on Medicare Advantage, help may be coming. On Oct. 16, the Centers for Medicare & Medicaid Services proposed a rule that would require Medicare Advantage plans to verify and update their provider directories at least every 90 days, report an accuracy score to CMS and display that score on their public directories. Enrollees who see an out-of-network provider because of a wrong listing would pay no more than in-network cost sharing.
“The actions we are proposing today will give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections, and greater confidence in both programs,” CMS Administrator Mehmet Oz said. The changes would apply starting in 2028 and are open for 60 days of public comment after publication in the Federal Register.
The proposal does not cover the commercial plans in the Ohio State study. Haeder said he would like to see one shared directory that clinicians maintain and every insurer can use, “rather than every insurer separately trying to maintain its own database.”
Mental health needs have grown fastest among young people, as we reported in our look at America’s teen mental health crisis. Families who hit a wall with their plan can also start with our guide to mental health resources.
Key takeaways
- Only 23.6% of evaluated secret shopper calls to in-network psychiatrists and psychologists led to an appointment.
- More than half of evaluated calls, 55.6%, hit inaccurate directory information, including disconnected numbers.
- Patients who did get appointments waited an average of 20.5 days.
- CMS has proposed 90-day directory checks and cost-sharing protections for Medicare Advantage, but not for commercial plans.
Frequently asked questions
What is a mental health ghost network?
It is an insurance provider directory that lists psychiatrists, psychologists or therapists who are not actually available to plan members, because of wrong contact details, clinicians who have moved or retired, or practices not taking new patients.
How hard is it to get a mental health appointment with insurance?
In the JAMA Health Forum study, only 23.6% of calls that reached a person at an in-network practice produced an appointment, and the average wait was 20.5 days.
What should I do if my insurer’s directory is wrong?
Write down the names, numbers and dates of each call, then contact your plan’s member services and ask for help finding an available in-network clinician. Under the No Surprises Act, people with commercial coverage who rely on an inaccurate directory listing generally should not be charged more than in-network cost sharing.
Will Medicare Advantage directories get better?
CMS has proposed requiring Medicare Advantage plans to verify directories every 90 days and publish accuracy scores, starting in 2028. The rule is not final.
