Hidden gaps in health insurance networks are hurting patients—but improvements have yet to show results
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You might think you're covered. You've paid your premiums, double-checked your provider list, and feel confident in the network promised by your insurance plan.
But then the moment comes when you or a loved one needs care. That network you trusted?
It turns out to be full of providers who are unreachable, unavailable, or don’t even take your insurance anymore.
For millions, this experience is not just frustrating—it’s a barrier to critical care.
They're called "ghost networks"—and they’re haunting insurance directories across the country. On paper, these networks seem robust and reliable. In reality, they’re full of dead ends: disconnected numbers, outdated locations, and long waitlists.
A mother named Michelle Mazzola found out the hard way when her toddler was diagnosed with autism. She began contacting providers listed by her insurer as "in-network," only to find most had disconnected lines, were full for months, or didn’t treat kids at all.
Out of roughly two dozen providers she tried, half the calls led nowhere. The rest told her to wait—some for nine months or longer. Her son needed early intervention, but access to care was just out of reach.
"You take it at face value when you’re buying a plan that this is what I’m getting," she said. "I would have gladly gone to any of those [in-network] providers if they actually were taking patients."
Michelle isn't alone. A recent review found that 81% of entries in major insurance directories were inaccurate. That includes incorrect specialties, wrong contact information, and listings for doctors who no longer take the plan.
In mental health, it's even worse. An investigation in one state found 86% of listed mental health providers were unreachable or didn't meet the directory claims. Another study revealed some Medicare Advantage directories had error rates as high as 93%.
Also read: Clock’s ticking: Americans have just weeks left to claim cash from $1.95M insurance settlement
Why does this keep happening? Experts point to multiple reasons: directories that aren’t updated, providers who fail to report changes, and systems designed more for billing than patient access.
In some cases, insurers may list providers to appear compliant with network regulations, even if they aren’t actually accessible.
The consequences go beyond inconvenience. They affect lives. Some patients give up seeking help. Others pay out-of-pocket, sometimes thousands of dollars a month. Michelle said her family spends nearly $7,000 monthly on care for her son.
Despite the scale of the issue, regulators have yet to meaningfully crack down. The No Surprises Act, implemented in January 2022, requires insurers to update directories every 90 days and reimburse patients when bad information leads them to go out-of-network.
Yet enforcement has been minimal. Investigations show that only a handful of fines are issued each year.
The legal system is now stepping in. Class action lawsuits have been filed, alleging deceptive advertising and contract violations. One such suit says insurers list unavailable providers to avoid paying for actual care, forcing patients to shoulder the financial burden themselves.
Also read: Are insurers profiting from your Medicare plan? New Trump DOJ lawsuit targets major insurance players
Former insurance insiders say they were pressured to inflate networks to meet quotas. One former network manager said they were pushed to show 100 autism specialists in a region, regardless of whether those doctors were really available.
Technology could offer solutions. AI tools may help verify and clean up provider directories, but change is slow. Some experts call for a national, centralized database for provider information—though that remains a long-term goal with logistical barriers.
System-wide change is necessary. Stronger penalties, tighter oversight, and better tools to keep provider data accurate are just the start. There also needs to be a fundamental shift in how insurers define and manage provider networks.
Read next: Still confused by Medicare? Let’s clear up 10 common myths seniors should know
Have you ever dialed number after number, only to hit a wall of bad information? Or discovered too late that your insurance plan’s "network" wasn’t much of one? You’re not alone. Your voice matters. If you’ve faced these barriers or found a way around them, share your story. The more people speak up, the more pressure there is for real accountability.
But then the moment comes when you or a loved one needs care. That network you trusted?
It turns out to be full of providers who are unreachable, unavailable, or don’t even take your insurance anymore.
For millions, this experience is not just frustrating—it’s a barrier to critical care.
They're called "ghost networks"—and they’re haunting insurance directories across the country. On paper, these networks seem robust and reliable. In reality, they’re full of dead ends: disconnected numbers, outdated locations, and long waitlists.
A mother named Michelle Mazzola found out the hard way when her toddler was diagnosed with autism. She began contacting providers listed by her insurer as "in-network," only to find most had disconnected lines, were full for months, or didn’t treat kids at all.
Ghost networks are haunting insurance directories across the country. Image Source: Mina Rad / Unsplash
Out of roughly two dozen providers she tried, half the calls led nowhere. The rest told her to wait—some for nine months or longer. Her son needed early intervention, but access to care was just out of reach.
"You take it at face value when you’re buying a plan that this is what I’m getting," she said. "I would have gladly gone to any of those [in-network] providers if they actually were taking patients."
Michelle isn't alone. A recent review found that 81% of entries in major insurance directories were inaccurate. That includes incorrect specialties, wrong contact information, and listings for doctors who no longer take the plan.
In mental health, it's even worse. An investigation in one state found 86% of listed mental health providers were unreachable or didn't meet the directory claims. Another study revealed some Medicare Advantage directories had error rates as high as 93%.
Also read: Clock’s ticking: Americans have just weeks left to claim cash from $1.95M insurance settlement
Why does this keep happening? Experts point to multiple reasons: directories that aren’t updated, providers who fail to report changes, and systems designed more for billing than patient access.
In some cases, insurers may list providers to appear compliant with network regulations, even if they aren’t actually accessible.
The consequences go beyond inconvenience. They affect lives. Some patients give up seeking help. Others pay out-of-pocket, sometimes thousands of dollars a month. Michelle said her family spends nearly $7,000 monthly on care for her son.
Despite the scale of the issue, regulators have yet to meaningfully crack down. The No Surprises Act, implemented in January 2022, requires insurers to update directories every 90 days and reimburse patients when bad information leads them to go out-of-network.
Yet enforcement has been minimal. Investigations show that only a handful of fines are issued each year.
The legal system is now stepping in. Class action lawsuits have been filed, alleging deceptive advertising and contract violations. One such suit says insurers list unavailable providers to avoid paying for actual care, forcing patients to shoulder the financial burden themselves.
Also read: Are insurers profiting from your Medicare plan? New Trump DOJ lawsuit targets major insurance players
Former insurance insiders say they were pressured to inflate networks to meet quotas. One former network manager said they were pushed to show 100 autism specialists in a region, regardless of whether those doctors were really available.
Technology could offer solutions. AI tools may help verify and clean up provider directories, but change is slow. Some experts call for a national, centralized database for provider information—though that remains a long-term goal with logistical barriers.
System-wide change is necessary. Stronger penalties, tighter oversight, and better tools to keep provider data accurate are just the start. There also needs to be a fundamental shift in how insurers define and manage provider networks.
Read next: Still confused by Medicare? Let’s clear up 10 common myths seniors should know
