U.S. Senators Seek Help for Patients Searching for In-network Providers

Bipartisan Group Addresses the Ghost Network Problem

A group of U.S. Senators, including Ohio's Sherrod Brown, is sending a bipartisan letter to United Healthcare, Aetna, Anthem Blue Cross Blue Shield, and Humana regarding “ghost networks” that present a challenge to patients who are searching for in-network providers.

According to a March 2022 report, challenges include inaccurate or out-of-date information on provider networks. Ghost networks occur when providers are on an insurer’s website as being in-network but are either no longer in-network, not accepting new patients, or may not still be in business. The problem of ghost networks is especially prevalent in mental health care, and the problem worsened during the pandemic as providers left their positions or stopped taking new patients due to overload.

“Ghost networks sow confusion and frustration among patients who are often in need of immediate care. Patients who lack the time and resources to sift through inaccurate provider directories may ultimately choose to forgo or delay needed health care. Others may be forced to pay out-of-pocket for a provider,” the Senators wrote.

Fourteen specific questions for providers were outlined by Senators in the letter, a few of those include:

~ How often do you update your provider network?

~ How often do you verify the accuracy of provider directory contact information?

~ Do you proactively perform any audits to determine if providers are no longer accepting new patients or remain in network, regardless of information received from providers?

~ What steps do you undertake if a provider notifies you that they will no longer accept new patients or remain in-network?

A draft of the latter is available at brown.senate.gov/imo/media