Wyden calls for insurers to face consequences for running 'ghost' provider networks

Sen. Ron Wyden, D-Oregon, called for insurers to face consequences when they run a “ghost network,” where providers are listed as part of the network but don’t offer care. 

Wyden told Fierce Healthcare that he remains committed to developing legislation to combat the practice as the Senate Finance Committee, which he chairs, undertakes a broad reform effort on mental health. While the panel has released drafts of legislation to tackle the mental health workforce shortage, it has yet to release text on tackling ghost networks. 

“There ought to be real consequences for running a ghost network,” he said Thursday. “You are taking money from people, hardworking- and middle-class people are forking over big sums of money and they think they ought to get some coverage rather than have a ghost network.”

Wyden declined to say what direction the Senate could take on the issue or whether insurers would face fines or similar penalties for the practice. He said that he remains in contact with colleagues on the issue, and the goal is to get something done before the end of the year. 

The senator referenced a report released in March (PDF) from the Government Accountability Office (GAO) that found barriers to accessing mental health services among some consumers. 

One of the barriers was networks where the providers listed as in-network did not actually accept any new patients or were not in the network. GAO referenced one study that looked at directories in three cities and found 22% of the phone numbers for psychiatrists were wrong, and 21% of them weren’t taking in any new patients. 

Wyden has also decried a lack of pay parity between behavioral and physical health services. The Affordable Care Act mandated plans must have parity in reimbursements for both physical and behavioral health, but there have been reports of insurers not adhering to this requirement. 

“Too many families in America are put through bureaucratic torment when they try to get that coverage,” Wyden said during a hearing in February.

The Senate, however, is running out of time to address the issue before the end of the year. Congress is expected to be out most of October for an election recess and other major issues such as funding the government loom large for the rest of this month.