So-called “ghost networks” have emerged as a significant problem in today’s health insurance landscape, particularly in the area of mental health and substance use disorder treatment. A ghost network exists when a health plan’s provider directory lists health professionals who are unavailable, not accepting new patients, no longer in network, or otherwise inaccessible in practice. While these directories may appear robust on paper, patients often discover that many of the health professionals listed in the directories are not actually available to treat them.
The consequences are substantial. Individuals seeking treatment may face long delays, repeated denials, or be forced to seek out-of-network care at significantly higher cost. These access barriers can be especially harmful when individuals are seeking mental health care, given the time-sensitive nature of many mental health conditions.
Both regulators and courts have increasingly recognized that inaccurate provider directories and inadequate networks undermine the core promise of health insurance coverage. As a result, ghost networks have become the focus of growing litigation against health plans nationwide. Plaintiffs have alleged that health plans misrepresent network adequacy, fail to maintain accurate directories, and systematically restrict access to mental health care while nominally claiming compliance with federal law.
Several legal frameworks may provide avenues for consumers and health care providers to challenge ghost networks. Under the Employee Retirement Income Security Act (“ERISA”), plan fiduciaries may face claims for breaching duties of loyalty and prudence by administering plans in a manner that deprives participants of promised benefits. The Mental Health Parity and Addiction Equity Act (the “MHPAEA”) prohibits non-quantitative treatment limitations that make mental health benefits more difficult to access than comparable medical benefits—an issue frequently implicated by ghost networks. In addition, the No Surprises Act imposes requirements regarding provider directory accuracy and consumer protections that may give rise to further health plan liability.
If you are a consumer or health care provider who has been impacted by ghost networks and believe you may have a legal claim against your health plan, please complete the following form and we will investigate your potential claim. The form can be found here.