#ghost providers

The networks claim to have providers, but they’re padded with practitioners who are no longer in the network, not taking new patients, or who have retired.

This seems like it could be a type of fraud. At the very least it appears to be some kind of false advertising.

“I Don’t Want to Die”: Needing Mental Health Care, He Got Trapped in His Insurer’s Ghost Network by Max Blau, illustrations by Vanessa Saba, special to ProPublica Sept. 8, 6:05 a.m. EDT Ravi didn’t know it, but he, like millions of Americans, was trapped in a “ghost network.” As some of those people have discovered, the providers listed in an insurer’s network have either retired or died. Many other providers have stopped accepting insurance — often because the companies made it excessively difficult for them to do so. Some just aren’t taking new patients. Insurers are often slow to remove them from directories, if they do so at all. It adds up to a bait and switch by insurance companies that leads customers to believe there are more options for care than actually exist. Ambetter’s parent company, Centene, has been accused numerous times of presiding over ghost networks. One of the 25 largest corporations in America, Centene brings in more revenue than Disney, FedEx or PepsiCo, but it is less known because its hundreds of subsidiaries use different names. In addition to insuring the largest number of marketplace customers, it’s the biggest player in Medicaid managed care and a giant in Medicare Advantage, insurance for seniors that’s offered by private companies instead of the federal government.

My letter to reps:

Health insurance plans, including Medicaid managed care privatized plans and Medicare Advantage plans need to be investigated for fraudulently pretending to have a bigger network of providers than is the reality. Propublica has reported in a Sept. 2024 article about the problem of “ghost networks” being rather widespread. It’s a danger to medical care and public safety. Whatever is leading to this misinformation, we obviously need stronger rules to prevent this kind of misinformation in provider lists.