On May 3, the Senate Finance Committee held a hearing on access to behavioral health care in Medicare Advantage (MA) and the problem of inaccurate provider directories. One area of focus in the hearing was “ghost networks”—MA provider networks that look more robust than they are because the underlying plan directories list providers who are not in the plan, no longer practicing, or not accepting new patients.
Inaccurate MA provider directories are a long-standing problem. For example, in 2018, the Centers for Medicare & Medicaid Services (CMS) found that 52% of provider locations listed in directories were inaccurate. But the problem goes much deeper than location. Preparatory to the hearing, committee staff conducted secret shopping and demonstrated how inaccurate provider directories could keep enrollees from scheduling appointments: “Staff reviewed directories from 12 different plans in a total of 6 states, calling 10 systematically selected providers from each plan, for a total of 120 calls. Of the total 120 provider listings contacted by phone, 33% were inaccurate, non-working numbers, or unreturned calls. Staff could only make appointments 18% of the time.”
If plan enrollees cannot access the care they need inside the network, they may experience harmful delays and extreme costs. Some may not be able to find an in-network provider in a timely manner or at all, while others may not be able to afford to go out of network. Those who do may not realize it comes with extra cost, and all may be forced to wrangle with their plan to cover their care. Such access barriers can lead to higher and more expensive care needs, including hospitalizations and emergency room visits.
The risks are especially acute in behavioral health, which encompasses both mental health and substance use disorders. A Government Accountability Office (GAO) report last year examining access to these services emphasized the prevalence of narrow and ghost mental health networks across payers, from MA to private health coverage. These network issues, coupled with prior authorization barriers, can delay or derail access to behavioral health care for plan enrollees.
At Medicare Rights, our experience confirms these findings. Provider directories, especially for behavioral health care, are often inaccurate, leaving MA enrollees scrambling to find and afford care. We are deeply concerned that each year, misleading or inaccurate plan directories may lock enrollees into a plan that does not cover the providers they need. We applaud the Senate Finance Committee for their important bipartisan work to shine a light on these issues.
Importantly, inaccurate directories and inadequate networks are not the only problems potential enrollees face when they are choosing an MA plan. In a new fact sheet on simplifying MA enrollment, we lay out additional options for improving the process.
We will continue to urge both Congress and the Biden-Harris administration to do more to conduct meaningful oversight, limit bad actors in the MA marketplace, improve decision-making, and increase transparency.
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