You still can’t trust Medicare Advantage plan provider directories

Back in 2019, I wrote a post for Just Care on why you can’t trust Medicare Advantage plan provider directories. Unfortunately, you can’t trust their ads, their sales agents, the quality of the health care providers in their networks or their coverage policies either. You are throwing darts when choosing a Medicare Advantage plan.

What’s particularly disturbing is that notwithstanding years of government oversight identifying untrustworthy provider directories, these directories remain untrustworthy. The Centers for Medicare and Medicaid Services, CMS, which oversees Medicare Advantage, has done little to hold Medicare Advantage plans to account for their failure to keep their directories accurate.

The Senate Finance Committee is looking into Medicare Advantage plans with “ghost networks.”  Ghost networks are, as their name implies, haunting and unreal. They are in-network providers listed in Medicare Advantage plan  provider directories who are not available to provide care. The Finance Committee issued a report on ghost networks for mental health providers.

No one knows for sure how common these ghost networks are, but Senate Finance Committee Majority staff found a lot of ghosts in a secret shopper study of mental health providers in Medicare Advantage plans. Out of 120 calls staff made, they were only able to make appointments 18 percent of the time. The inaccuracy rate was more than 80 percent. The vast majority of providers listed were either not able to be reached, out of network, or not taking new patients.

Some plans did better than others and availability was better in some states. But, in Oregon, Chairman Wyden’s home state, staff could not make an appointment at all. In Colorado, they were able to make an appointment half the time. In some cases though, appointments were available only many months down the road. Moreover, some offices required additional information before scheduling an appointment; Senate Finance staff could not confirm whether appointments would be scheduled once that information was provided. If not, the provider directories would only have been accurate 13 percent of the time.

Senate Finance is suggests minor steps to correct what can be a huge issue for Medicare Advantage enrollees in need of critical care. It is also a persisting issue. Rather than recommending an open network in any MA plan with inaccurate provider directories–the only fair solution to ensure MA enrollees access to needed care–they want more CMS oversight and financial penalties.

Given mental health parity laws and the fact that one in five adults–nearly 60 million Americans–have a diagnosable mental health illness, access to mental health providers should be easy. Without treatment, people often suffer considerably and can become increasingly ill or even die.

In their report, staff did not name the MA plans they looked into, let alone the names of the worst actors, which would be helpful information for people deciding among MA plans, particularly people with mental health needs. How is it that we know more about differences among restaurants and refrigerators than we do about Medicare Advantage plans?

Here are the Finance staff findings on the rate of ghost listings by state:

Appendix Table 1. Overall and By State Call Results