Accessing behavioral health care in the U.S. is already full of hurdles—stigma, cost, provider shortages—but one lesser-known obstacle is quietly worsening the crisis: inaccurate health plan directories, or what experts now call ghost networks. These ghost networks refer to directories that list behavioral health providers who are either unreachable, no longer practicing at the location listed, or not accepting new patients. To the average person seeking help, these directories give the illusion of access—until they start calling around and discover the truth. The result? Patients are delayed or deterred from getting the care they need, prices climb due to lack of competition, and providers lose out on connecting with clients who are actively looking for them. This is one of the more invisible but deeply harmful behavioral health access issues in the system.
A new study published in BMC Health Services Research confirms what many clinicians and patients already know: these inaccuracies are widespread and persist despite regulations meant to fix them. And for individuals already struggling to navigate the behavioral health system, these phantom listings can be the final straw.
The Real Impact of Ghost Networks
Ghost networks don’t just frustrate—they harm. Behavioral health patients often face unique barriers just to decide to seek help in the first place. Whether it’s shame, fear of being judged, or uncertainty about what kind of help they need, the decision to reach out can be a vulnerable moment. When patients take that step and are met with disconnected phone numbers or incorrect addresses, it creates a disheartening experience that can stop them from trying again.
“It is often challenging for patients to realize they have a behavioral health need and seek care,” said Dr. Neel Butala, chief medical officer at AI company HiLabs and the study’s lead author. “Once patients make the decision to seek care, they often run into barriers to make an appointment due to inaccurate provider directories.”
These directories, often riddled with errors, contribute directly to behavioral health access issues, making it even harder for people to begin treatment. The researchers analyzed over 440,000 provider listings from five of the country’s largest insurance companies—UnitedHealth, Elevance, Cigna, Aetna, and Humana. The study focused on behavioral health specialists, such as psychiatrists and neurologists, and found alarming rates of inaccuracy:
- Only 16% of providers had correctly listed phone numbers
- Only 28% had accurate addresses
That means the vast majority of people seeking care had to wade through outdated or misleading information—costing them time, energy, and in some cases, worsening mental health symptoms due to delays in treatment. These directory flaws intensify behavioral health access issues at the point when timely intervention is often most critical.
A Systemic Problem Across the Industry
Perhaps even more troubling is the scope of the problem. The inaccuracies were not limited to a particular insurer, state, or physician specialty. The researchers found minimal variation between insurers, which points to a systemic failure rather than a few isolated cases. In fact, the study follows up on similar research conducted in 2023, which revealed that 81% of physician listings across various specialties had inconsistencies in directory data.
“The low variation in physician data consistency by insurer is suggestive of the systemic nature of the provider data quality problem across insurers, irrespective of individual insurer processes,” the study’s authors noted.
The implication is clear: it’s not just one company dropping the ball—it’s the entire system. And without significant change, behavioral health access issues will remain entrenched in the way care is delivered.
Interestingly, the study also found that specialties with more direct patient interaction, such as dermatology or plastic surgery, tended to have more accurate listings. These specialties often rely on referrals or direct outreach via provider directories. Behavioral health, on the other hand, often flies under the radar, leading to lower accountability when it comes to maintaining updated contact information.
Why Regulations Like the No Surprises Act Aren’t Working
In response to mounting criticism over ghost networks, lawmakers introduced the No Surprises Act, which went into effect in 2022. Among its many provisions, the law requires health insurers to keep their provider directories updated—removing or correcting inaccuracies promptly.
But this latest research suggests that even with regulations in place, the problem persists. Why?
According to Butala and his team, enforcement has been weak or inconsistent. Without strict penalties or meaningful oversight, many insurers have little incentive to invest in cleaning up their directories. In other words, the law exists—but there’s no real pressure to follow it.
“Unfortunately, no insurer seemed to have solved this problem and state-level regulations or enforcement of regulations did not correlate with the degree of inaccuracy,” Butala explained.
That’s a sobering reality. While the intent behind laws like the No Surprises Act is noble, the lack of follow-through undermines its effectiveness—leaving patients no better off than before. Without real change, these inaccuracies will continue fueling behavioral health access issues across the country.
What’s Being Done Now?
In light of these findings, lawmakers have introduced new legislation aimed specifically at ghost networks.
In early 2024, senators proposed the Behavioral Health Network and Directory Improvement Act, which would empower the federal government to independently audit health plans’ directories. This represents a more aggressive stance—shifting the burden of proof onto insurers rather than relying on patients or providers to report errors.
Additionally, the REAL (Requiring Enhanced & Accurate Lists) Health Providers Act, introduced in 2023, targets Medicare Advantage plans, where seniors have been especially vulnerable to ghost network frustrations. The bill aims to strengthen directory accuracy requirements and protect elderly patients from the burden of calling multiple numbers just to find one working provider.
These legislative efforts are promising, but without strong enforcement mechanisms, they may not go far enough to eliminate the behavioral health access issues caused by inaccurate directories.
A Tech-Driven Path Forward
So what can be done?
For Butala, the ideal solution would be to treat provider data with the same seriousness as claims data. The insurance industry already has standardized systems for processing and verifying billing information—why not do the same for provider directories?
“The ideal way to improve ghost networks would be to create an industry standard for provider data,” he said. “But implementation would be difficult, since it would require alignment across many stakeholders and could lead to technical and operational issues.”
In other words, the challenge is not just technological—it’s organizational. Insurers, providers, government agencies, and software vendors would all need to work together, and that level of collaboration is notoriously difficult in a fragmented health care system.
Still, there’s hope. Butala suggests a more realistic option: leveraging AI-driven solutions to automatically flag outdated listings, correct errors, and reduce the manual labor currently required. These tools, like the ones used in the study, could identify issues before they reach patients and help close the gap in behavioral health access issues.
Including Providers in the Conversation
One final, crucial insight from the study: improving directories isn’t just about insurers. Providers themselves need to be part of the process.
Far too often, mental health professionals—many of whom are working in small practices or even solo—are left out of the loop when it comes to updating directory information. The study’s authors suggest that any future legislation must actively incorporate provider groups into the workflow, not just hold insurers accountable.
By creating systems where providers can more easily and consistently update their information—or where directories are linked directly to credentialing and claims systems—the accuracy problem could be addressed from both ends, reducing the behavioral health access issues caused by outdated data.
Final Thoughts
The ghost network crisis is a silent but powerful barrier in the U.S. behavioral health system. While legislation has attempted to tackle the problem, meaningful solutions remain elusive. The path forward will require a mix of smart policy, proactive enforcement, cross-industry collaboration, and the use of innovative technology.
Until then, patients will continue to struggle to find help in a system that often looks accessible on paper—but feels like a dead end in reality.
For the millions of Americans facing mental health challenges, we need more than promises. We need action—and we need it now—to address the real, human consequences of behavioral health access issues.
