Ghost network
A ghost network is a health plan network that looks larger on paper than it is in practice: providers are listed as in-network and available, but have moved, retired, left the network, aren't taking new patients or can't be reached.
How do ghost networks happen?
Usually through stale directory data rather than intent. A provider leaves a group or stops seeing a plan's members, nobody updates the directory, and the listing stays. Each wrong listing looks like real capacity, so the network appears to meet access standards when members can't actually get appointments.
Who is affected most?
Researchers and regulators have paid particular attention to mental health, where members calling listed providers often find they are not available. A 2020 study in Health Affairs found people using mental health directories reported inaccuracies more often than those looking for medical care.
How are ghost networks found and fixed?
Secret shopper calls find them one listing at a time. Checking listings against evidence of real activity, such as recent claims at that location, finds them across a whole directory. Fixing them means removing or correcting the listing, which the No Surprises Act requires when a provider can't be verified.