Busting Ghost Networks: What You Can Do on the Back End

Ghost networks — health plan listings containing inaccurate information such as outdated addresses or contact information, or providers who aren’t accepting new patients or don’t take that plan’s insurance — can lead to delayed care, health issues and financial challenges for your employees.

Despite your best efforts to avoid ghost networks on the front end, your employees may still encounter problems.

“Ghost networks create a false sense of availability,” said Erin Terkoski Young, the director of health, equity and well-being at WTW. “In the face of urgent needs, such as mental health, employees need access quickly, and directories need to be accurate. In a crisis, an employee or family member of someone in crisis cannot spend hours calling through a list to find an available provider.”

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A ghost network means employees aren’t getting the care they need, and employers aren’t getting the health plans they paid for, which is particularly problematic given the continually increasing health costs employers are juggling. Taking measures prior to selecting a plan can help, but even once you’re locked in for the year, there are steps employers can take when workers run into a ghost network.

Have a Plan in Place

Part of offering health insurance is ensuring employees can access care — so it’s important that human resource departments are prepared to advocate for them. HR and total rewards professionals should be aware of their role and be equipped to help employees running into difficulties with ghost networks, said Abigail Burman, a consumer protection attorney at law firm Motley Rice LLC.

That may start with an HR representative making additional calls from the directory if an employee has already unsuccessfully contacted a certain number of providers. But it could also involve escalating the issue to hold the health insurance company to its contractual agreement to provide in-network care. When signing a contract, your organization should get phone and email information for a direct contact at the insurance company who can immediately help address inaccurate provider listings, Burman said.

“Health insurance is considered a part of people’s salary,” Burman said. “If they can’t find a doctor, then it’s not a meaningful contribution to their overall compensation.”

Create the Right Culture

HR can’t help to resolve ghost network issues if employees don’t know they should bring them up — or if they don’t feel comfortable doing so.

“Ghost networks are something a lot of people experience, but people tend to think it’s their fault for not being better at insurance,” Burman said. “They don’t connect it to a systemic issue.”

It’s important to create a work environment in which workers feel empowered to bring up issues with their health insurance, Young said.

Employers and their HR and TR pros should also consistently train managers and supervisors to respond to employees’ concerns about health plans and direct those questions and comments to the HR department, said Sue Abderholden, the executive director of the Minnesota chapter of the National Alliance on Mental Illness, who has worked for years to address limited access to care.

It can also be helpful, Abderholden added, to regularly survey employees about specific issues they’ve run into with accessing care, reaching offices or visiting providers who turned out not to be in-network.

Speak Out

For employers that encounter issues with ghost networks — or simply want to reduce the likelihood they will in the future — making some noise can help, said Jake Gardener, an attorney and partner at Walden Macht Haran & Williams LLP and co-counsel in a ghost network class-action lawsuit.

If employers do encounter ghost networks while researching plan options for their workers, they can also seek out attorneys involved in litigation related to inaccurate directories, he said.

“Sharing the information with someone who can do something about it, whether it’s a government regulator or a lawyer or even just the insurance company itself, is one way you can try to combat ghost networks,” Gardener said. “I’m hopeful our litigation creates a domino effect, and we begin to hold insurance companies accountable for a problem that everyone, including the U.S. government, has acknowledged is industrywide.”

Lodging a complaint with the U.S. Department of Commerce about issues with a payor is another option for employers, Abderholden said, as is reaching out to legislators.

Doing so can pay dividends. For instance, legislation introduced by U.S. Senators Tina Smith (D-Minnesota) and Ron Wyden (D-Oregon) would require directory audits, reimbursement for patients if they see a provider wrongly listed in-network and penalties for insurance companies that provide inaccurate information.

“When companies contract with insurance companies to provide benefits to their employees, like healthcare, the companies expect their insurance plans to be compliant with the law,” said Charlotte Hoffman, a spokesperson for Senator Smith. “That includes … ensuring that their employees can access the care they are paying for.”

Being the squeaky wheel is an important way to advocate for better care for your employees, Burman said.

“I’d recommend that employers step up and be active in advocating for better regulations,” she said. “Businesses have a really important voice here that is very effective when it is heard.”

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