Committee staff conducted a “secret shopper” study, calling behavioral health providers listed in 12 Medicare Advantage plan directories in six states.
Of 120 providers staff contacted, 33 percent had inaccurate numbers or did not return calls. The report called networks “haunted” by ghost entries.
The Senate Finance Committee held a hearing on improving provider directories on May 3.
In his opening remarks, Mr. Wyden, an Oregon Democrat, said ghost networks add unnecessary barriers to mental health treatment.
“When insurance companies host ghost networks, they are selling health coverage under false pretenses, because the mental health providers advertised in their plan directories aren’t picking up the phone or taking new patients,” Mr. Wyden said. “In any other business, if a product or service doesn’t meet expectations, consumers can ask for a refund.”
The committee’s ranking member, Sen. Mike Crapo, an Idaho Republican, said improved provider directories will strengthen Medicare Advantage.
“While we work to better align incentives to improve provider directory accuracy, however, we must do so without increasing burdensome requirements that will only weaken our mental health workforce,” Mr. Crapo said.
“Regulatory red tape and reimbursement strain, among other factors, can also decrease patient access, exacerbating physician shortages, compounding burnout, and eroding healthcare access and quality,” he added.
