Directory errors linked to bills for out-of-network mental health providers

Encountering incorrect information in the directory of an insurance provider is associated with use of out-of-network mental health providers and unexpected bills for outpatient services, researchers led by the Yale School of Public Health found in a new study.

The research, done in collaboration with NYU School of Medicine, is published in the journal Health Affairs.

Mental health services are up to six times more likely than general medical services to be delivered by an out-of-network provider. Provider directories help patients identify mental health providers that accept their insurance. Incorrect information in directories may result in delays in care, the inability to locate a participating mental health provider with available appointments, or the receipt of a “surprise bill.” Moreover, regulators may rely on directory information to determine if a plan has an adequate number of mental health providers in their network.

To investigate whether encountering incorrect directory information was associated with out-of-network mental health care, the researchers conducted a national survey of 831 privately insured patients who used mental health services. The research team found that 44% of respondents used a mental health provider directory in the past year, with those with a more serious illness most likely to use the directory.

“This suggests accurate directories have the potential to be a useful tool for patients to help them locate a mental health provider that meets their needs,” said Susan Busch, professor at the Yale School of Public Health and the study’s corresponding author.

About one-third (36%) of respondents who used a directory reported encountering either incorrect provider contact information or a provider listed in the directory incorrectly as accepting their insurance-two of the most fundamental pieces of information in directories. More than half (53%) of participants reported encountering at least one directory problem in the past year.

Those who encountered incorrect information were twice as likely to be treated by an out-of-network provider (40% versus 20%). “Our study suggests that directory accuracy is a significant barrier for individuals seeking to use mental health services,” said Busch. “Insurers have a responsibility to provide correct and up-to-date information to plan enrollees.”

In addition, those who encountered directory inaccuracies were four times more likely to have a surprise outpatient bill (16% versus 4%). They did not know they were seeing an out-of-network mental health provider until arriving for their first scheduled appointment.

Associations between directory accuracy and out-of-network care may also be indicative of inadequate mental health networks. Some have used the term “ghost” or “phantom” networks to describe providers listed in directories that are unreachable or not taking new patients.

“In the face of an inadequate network, even if a patient knowingly “chooses” to go out-of-network, their decision may be influenced by a lack of timely access to high-quality in-network providers.” said co-author Kelly Kyanko, professor of medicine at NYU Langone.

The study results come with a caveat, said Busch: “It is important to note that we could not assess whether the patient would have been able to locate an in-network provider if the directory had been accurate. We only note associations. We need additional work to determine if more accurate directories would allow more patients to find in-network providers, reducing the financial burden on patients.”

The study authors noted that a federal standard for directory accuracy or stronger enforcement of existing state laws may be needed to address the problem of incorrect directories.

This research was supported by a grant from the National Institutes of Mental Health.

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