The Mental Health Crisis: Exposing Ghost Webs | Arnall Golden Gregory LLP

As the United States continues to grapple with a growing mental health crisis, millions are finding it increasingly difficult to access and afford mental health treatment. Recent investigations conducted by the New York Office of the Attorney General (“OAG”) have uncovered a disturbing trend known as “ghost networks” that exacerbates this problem. Through mental health hearings, complaints to the New York City Health Bureau Hotline, and extensive research, the OAG recently released a comprehensive report describing a significant gap in the availability of mental health services across the state, and the OAG’s findings are likely to be applicable to other countries.

According to the report, one of the main obstacles facing those seeking mental health treatment is the presence of inaccurate provider directories or unavailable providers, commonly referred to as “ghost networks.” These shadow networks prevent consumers from accessing treatment using their health insurance benefits, often forcing them to make the challenging decision to pay out of pocket or go without essential care, with potentially dire consequences for their mental health.

To quantify the extent of this problem in New York State, the OAG conducted a large-scale statewide “mystery shopper survey” involving 13 health plans. These include well-known names such as Aetna, CDPHP, Cigna and UnitedHealthcare. As part of that investigation, directories were checked and inquiries were made to at least 20 providers in major cities served by the plans, including New York, Albany, Buffalo and Rochester. The callers were intended to schedule appointments with mental health providers listed as accepting new patients.

The study revealed shocking findings. Success rates for the 13 health plans ranged from 0% to as low as 35%. Among the 396 providers we contacted across all plans, callers secured appointments only 14% of the time, meaning a staggering 86% of the mental health providers listed in the network were essentially “ghosts” — unavailable, not in network or not accepting new patients.

Ghost webs are not only problematic, but also illegal. Both state and federal laws require the maintenance of accurate provider directories. Specifically, commercial health plans, qualified health plans (“QHPs”) issued under the Affordable Care Act, and Medicaid plans are required to maintain accurate online provider directories. The No Surprises Act also requires all private health plans to maintain accurate online provider directories, review their directories at least every 90 days, and post any changes to those directories within two business days.1 Plans must also implement in-network cost sharing for covered services provided by providers inaccurately identified as in-network.2 In addition, CMS regulations require QHPs to publish an up-to-date, accurate, complete, and accessible directory of providers, noting each provider’s location, contact information, specialty, institutional affiliations, and whether new patients are accepted.3 Finally, effective July 1, 2025, Medicaid fee-for-service4 and managed care plans5 must maintain accurate provider directories that indicate whether providers are accepting new patients.

The findings of the OAG investigation highlight the barriers many patients face when seeking mainstream mental health treatment. To that end, the OAG recommended various regulatory changes, increased enforcement, and significant actions by health plans, including:

  • Requiring health plans to conduct regular audits of their provider networks (including secret shopper surveys) to verify compliance with requirements for directory accuracy, network adequacy, and mental health parity, and to report the results to regulators, who will make them available on a public website.
  • Establishing robust standards for wait times for mental health treatment appointments so that consumers can promptly receive the services they need.
  • Require health plans to analyze and submit data on key indicators of network adequacy to regulators.
  • Require health plans to improve inadequate networks, ensure that network providers are culturally and linguistically competent, and improve consumer complaint mechanisms.
  • Vigorously enforce the law and impose consequences for violations, including monetary penalties.
  • Explore the possibility of a centralized provider directory for all health plans, which could improve compliance and access to treatment.

For more information and to access the full OAG report, please click here.

[1] 42 USC § 300gg-115(a), which is effective for plan years beginning on or after January 1, 2022. Although regulations have not yet been issued, plans must comply. Department of Labor, Health, and Human Services and Department of the Treasury, FAQs on the Affordable Care Act and the Consolidated Appropriations Act of 2021 Implementation Part 49 8 (Aug. 20, 2021), https://www.dol .gov/sites /dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-49.pdf.
[2] 42 USC § 300gg-115(b).
[3] 45 CFR § 156.230(b)(2).
[4] 42 USC § 1396a (83).
[5] 42 USC § 1396u-2(a)(5).

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