JAMA Study: Commercial Insurance Directories Yield Mental Health Appointments in Only 24% of Calls

Researchers at Ohio State University placed calls posing as patients seeking care for anxiety or grief. They reached a live person in only 2,252 instances; the rest hit automated systems or disconnected lines. Among those, 56% encountered inaccurate contact details, 22% faced providers not accepting new patients, and average wait times reached 20.5 days, longer for psychiatrists. The study appears in JAMA Health Forum.

These ghost networks reflect systemic incentives: insurers maintain large but outdated lists to satisfy network adequacy rules while clinicians frequently change affiliations without directory updates. Similar patterns appear in prior secret-shopper work on primary care and specialty directories, including a 2022 GAO report documenting 40-60% inaccuracy rates across Medicare Advantage plans. The disconnect leaves commercially insured patients functionally underinsured for mental health.

The design cannot capture patients who never attempt calls due to directory frustration or those who accept out-of-network options at higher cost. Next steps require centralized, clinician-maintained directories with real-time verification, tested through repeated audits rather than one-time studies. Evidence quality is moderate: rigorous secret-shopper methodology in five states but limited to commercial plans and two conditions.