Researchers posed as patients and called in-network mental health providers, and fewer than 1 in 4 calls that reached someone got an appointment

If you have health insurance and need a therapist or psychiatrist, the first step is usually the same: open your plan’s directory and start calling the names listed as in-network. Researchers at Ohio State University wanted to know how well that actually works. So they did it themselves, thousands of times, posing as patients with commercial insurance in five US states. Most of the calls went nowhere.

Of the calls that reached a real person at a listed psychiatrist’s or psychologist’s office, only 24% ended with an appointment with the clinician named in the directory. Counting any clinician at that practice, the figure rose to 31%. More than two-thirds of the time, a caller who got through still walked away with nothing.

And those were the lucky calls. More than 60% of the calls to listed psychiatrists and psychologists could not be evaluated at all. The researchers analyzed the 2,252 calls that did reach a person.

Researchers call this a ghost network: a list of providers that exists on paper but not in practice. In more than half of the calls that got through, the directory listing itself was wrong: the clinician had moved, changed numbers, left the practice or was otherwise unavailable. In another 22% of calls, the provider existed but was not accepting new patients.

“Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes aren’t always reflected in insurance directories,” lead author Simon Haeder said in a statement.

Ghost networks are not a new complaint, but most of the hard evidence has come from public insurance. A 2022 study of Oregon Medicaid in Health Affairs found that a large share of mental health clinicians listed in Medicaid networks saw few or no Medicaid patients over a year. The new study shows the same pattern in commercial insurance, the plans most working Americans get through their jobs.

The method is called a secret shopper study. Callers contacted psychiatrists and psychologists listed in the directories of commercial health plans, posing as new patients, and recorded what happened on each call. The study was approved by Ohio State’s research ethics board.

The second finding is what this does to patients. Someone looking for help with depression or anxiety may have to work through a long list of names, often while unwell, to find one clinician who will see them. The researchers say ghost networks create substantial barriers to care and leave people effectively underinsured despite having insurance.

“Our study speaks to a broader problem in American health care: the disconnect between having health insurance and actually being able to use it,” said co-author Wendy Xu, a professor of health services management and policy at Ohio State.

It fits a pattern in how health care is organized behind the scenes. Earlier this month we reported on a study linking for-profit hospital ownership to more patient deaths, partly through understaffing that patients never see.

If you are searching for mental health care through your insurance, ghost networks are worth planning around. Ask each office directly whether the clinician is taking new patients and still accepts your specific plan, and keep a record of the calls. It can also be worth calling the plan itself. In the US, if you rely on an inaccurate directory and end up seeing an out-of-network provider, federal rules generally limit what your plan can charge you to in-network cost-sharing.

There are limits to what this shows. The study covered five states and commercial plans only, so results may differ elsewhere and for Medicare or Medicaid. A secret shopper call captures one moment, and some offices may have had openings on another day. Psychiatrists and psychologists were included, but other therapists such as counselors and social workers were not.

Source

Haeder S, Lou Y, Xu W, Miller BF. “Mental Health Ghost Networks in Commercial Insurance Plans.” JAMA Health Forum, 2026.
DOI: 10.1001/jamahealthforum.2026.3746

Also cited

Zhu JM, Charlesworth CJ, Polsky D, McConnell KJ. “Phantom networks: discrepancies between reported and realized mental health care networks in Oregon Medicaid.” Health Affairs, 2022.
DOI: 10.1377/hlthaff.2022.00052