Medicare Advantage Provider Directories Are Inaccurate, Study Finds

Medicare Advantage provider directories are inaccurate, hindering beneficiaries’ access to mental healthcare, according to a secret shopper survey conducted by the Senate Finance Committee.

When a health plan’s provider directory consists of inaccurate listings or unavailable providers, it is known as a ghost network.

The Senate Finance Committee’s majority staff reviewed directories from 12 Medicare Advantage health plans in six states to determine the prevalence of mental health provider ghost networks in the private program. Staff called ten providers from each plan to schedule an appointment for an older adult family member with depression.

Among the 120 provider listings contacted, 33 percent were inaccurate, non-working numbers, or resulted in unreturned calls.

Staff could only make appointments for 18 percent of the listings, with appointment rates ranging from 0 percent in Oregon to 50 percent in Colorado. This translated to only two calls resulting in an appointment for every ten calls.

“In a moment of national crisis about mental health, with the problem growing exponentially during the pandemic, the widespread existence of ghost networks is unacceptable,” Senate Finance Committee Chair Ron Wyden (D-OR) said. “When someone who’s worried about their mental health or the mental health of a loved one finally works up the courage to pick up the phone and try and get help, the last thing they need is a symphony of ‘please hold’ music, non-working numbers, and rejection.”

More than 80 percent of the listed mental health providers were considered ghosts, as they were unreachable, not accepting new patients, or not in-network. In some instances, staff could not schedule appointments because the mental health provider required a referral from a primary care provider.

Among staff who connected with a working telephone number, multiple times the number listed was for a different entity, the survey found. For example, mental health provider listings for one plan led to a high school student health center, a nursing station at an inpatient psychiatric facility, and a nonprofit organization that manages logistics for peer support groups.

Another plan’s mental health provider listing led to a mental health specialist located in a different state. The specialist’s office indicated that the providers had notified the health plan multiple times of this discrepancy.

In six situations, calls were directed to a national third-party provider matching service that indicated providers were available but asked staff to submit additional information about the patient’s health needs and insurance to receive an appointment date and provider name.

The survey considered these cases successful appointments, assuming an appointment would be scheduled if the additional information was submitted. If not, the appointment success rate would have dropped to 13 percent.

The time required for staff to reach providers ranged from one to three hours to contact ten listings per plan. When staff could make an appointment, some were offered within a month, while others could only schedule an appointment for several months out. The earliest available appointment in one case was in ten months, the survey noted.

Inaccurate provider directories can make it difficult for beneficiaries to receive the care they need. Alternatively, calling providers before enrolling in a plan to confirm their participation can create additional burdens for beneficiaries.

While Medicare regularly audits plans offering coverage to seniors, CMS does not routinely audit Medicare Advantage provider directories, according to the Senate Finance Committee.

“In my view, eliminating ghost networks is going to require a three-legged approach: more audits, greater transparency, and stronger consequences for insurance companies that don’t keep their directories up to date,” Sen. Wyden added.