Fewer than a quarter of secret shopper phone calls to a mental health provider listed as in-network for large commercial insurance plans ended in a scheduled appointment, with many attempts hampered by inaccurate provider directories or capacity constraints, according to a peer-reviewed study published Friday.
The project from Ohio State University and Stanford University researchers involved more than 5,800 calls to listed psychiatrists and psychologists between October 2025 and March 2026 to better understand the scope of so-called “ghost networks” that critics say hamper patients’ access to care.
Among the 2,252 calls that reached a human answerer and could be evaluated—excluding, for instance, those that reached an answering machine or another automated system with no option to speak to staff—23.6% resulted in a scheduled appointment, though that rose to 31.1% when the caller said they would be willing to book with another available clinician.
“Access to mental health care in the U.S. is a well-documented struggle,” Simon Haeder, associate professor of health services management and policy at the Ohio State University’s College of Public Health, said in a statement shared by the school “This shows that even those with private insurance, who are told they have many providers to choose from, can have a hard time getting the care they need.”
The study’s callers simulated patients with a nonemergency mental health condition in five states who were enrolled in a preferred provider organization plan of their state’s predominant commercial carrier: Blue Cross Blue Shield of Rhode Island, Blue Cross and Blue Shield of Montana, CareFirst BlueCross BlueShield (Virginia), Highmark Blue Cross Blue Shield Delaware and Horizon Blue Cross Blue Shield of New Jersey. For each simulated patient, they sought to contact the geographically nearest clinician listed on each carrier’s online provider directory.
The 23.6% appointment success rate was roughly similar between psychiatry and psychology care providers, and between carriers ranged from 18% in Virginia to 32.9% in New Jersey. Rural clinicians were more often likely to offer appointments than nonrural clinicians.
When appointments were secured, the average wait time was 20.5 days, but longer for psychiatry care than psychology, whereas the simulated patients’ average travel time to their appointment was 17.1 minutes but substantially higher for rural patients (30.8 minutes average travel time).
As for why so few of the calls ended in appointments, the researchers noted that 55.6% of the 2,252 evaluated calls involved inaccurate information in the insurer’s provider directory, most often relating to incorrect contact information and “including [11.4%] that reached a disconnected or out-of-service number.” Nearly 22% were stymied by the contacted provider’s capacity limitations, and this was more common for psychology services than psychiatry.
“Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes aren’t always reflected in insurance directories,” Haeder said. “Seeking help can already be difficult for someone experiencing anxiety, grief or another mental health concern and that’s exacerbated when they’re running into answering machines, unavailable providers and ‘in-network’ psychologists who’ve moved to another state.”
The researchers wrote that their work suggests “the pathway from network directory to actual care may often be broken,” and raises questions as to whether the fault predominantly lies in directory maintenance or characteristics of the mental health practices themselves. They also noted that their findings come three years after directory accuracy provisions of the No Surprises Act took effect, indicating that “existing regulatory requirements are insufficient or lack meaningful enforcement mechanisms.”
Haeder, in his institution’s release, said he’d “love to see a centralized provider directory that clinicians maintain and insurers can access, rather than every insurer separately trying to maintain its own database.”
The Centers for Medicare and Medicaid Services has taken steps toward a national provider directory for its Medicare patients, late last year standing up a preview release that displays provider data integrated from multiple sources.
On Friday, CMS also took steps to crack down on inaccurate provider directories among Medicare Advantage plans, proposing a rule that would require them to verify and update their listings at least once every 90 days. Patients who receive care from a provider that turned out to be incorrectly listed as in-network would also be shielded from elevated cost sharing under that proposal.