Mental health ghost networks reach well beyond public insurance programs. Directory errors affected 55.6% of evaluable secret shopper calls to psychiatrists and psychologists listed by the largest commercial carrier in each of five states, according to a study published Oct. 16 in JAMA Health Forum.
Researchers from the Ohio State University’s College of Public Health in Columbus and Stanford (Calif.) University School of Medicine analyzed 5,822 secret shopper calls made between October 2025 and March 2026. Callers posed as relatives of preferred provider organization plan members with nonemergency mental health conditions. They contacted clinicians listed in the directories of six Blue Cross Blue Shield licensees in Delaware, Montana, New Jersey, Rhode Island and Virginia.
Of the 5,822 calls, 61.3% produced no definitive outcome, most often because callers reached only voicemail or an automated system. Among the 2,252 evaluable calls, 23.6% ended with an appointment with the listed clinician. That rate rose to 32.1% when other clinicians at the same number were counted. Across all initial attempts, just 12.4% of calls led to a booked appointment with any clinician.
Wrong contact information was the most common directory error, at 31%, followed by incorrect specialty listings at 22.2%. Capacity limits, such as clinicians not accepting new patients, blocked scheduling on another 21.6% of evaluable calls.
Callers who secured appointments waited 20.5 days on average: 22.5 days for psychiatry and 17.3 days for psychology. Average travel time was 17.1 minutes overall but reached 41.8 minutes in Montana and 30.8 minutes for rural residents.
Horizon Blue Cross Blue Shield of New Jersey had the highest appointment success rate, at 32.9%. CareFirst BlueCross BlueShield, a secondary carrier included in Virginia because Anthem doesn’t cover the entire state, had the highest directory error rate, at 70.8%, though it accounted for just 42 evaluable calls.
The researchers said the No Surprises Act’s 90-day directory verification requirement has not solved the problem. They urged regulators to shift to audit-based verification and to tie network adequacy standards to wait times and appointment availability.
The researchers called the audit the largest mental health secret shopper study to date, to their knowledge, and said access barriers at smaller carriers are likely worse.
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