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Ghost Networks: The Therapists Who Aren't There

by Caleb Dang

It’s been weeks of lying awake at 3 a.m., and you finally admit you can't do this alone. You decide to get help, and surprisingly that turns out to be the easy part. You open your insurer's website, filter to "in-network" therapists, and start calling. The first rings into voicemail. The second immediately disconnects. A receptionist at the third says the therapist retired years ago. The fourth tells you that they never took your insurance at all. The list looks full; yet, not one therapist can actually see you. After a week of dead ends, you start to wonder whether seeking mental health care was worth trying at all.

This phenomenon even has a name: a ghost network, which is an insurer's directory that lists providers who are unreachable, not accepting new patients, or not actually in-network. In fact, when the Senate Finance Committee staff called mental health providers listed across a dozen Medicare Advantage plans, more than 8 in 10 turned out to be ghosts, and they could book an appointment only 18% of the time . Here's the real problem: even if the general public believes mental health matters, funding it is a whole different story.

We say mental health matters

Public opinion has changed in the past decade. In an American Psychiatric Association poll, about 79% of U.S. adults called the current state of mental health in the U.S. a public health emergency that deserves more attention from lawmakers, and a similar share said mental health directly affects physical health. Due to public awareness campaigns and public figures like Simone Biles speaking openly about their own mental health struggles, stigma has noticeably softened, and campaigns urging people to seek help are more mainstream nowadays.

Still, it seems that the system lags behind the sentiment. Roughly 3 in 4 say mental health is less likely to be identified and treated than physical health, even as most believe mental health problems are getting worse When asked what stands in the way, the top two barriers named were affordability (~52%) and difficulty finding a provider (~42%), both of which are difficult to address in our current healthcare system.

How widespread ghost networks are

Ghost networks aren’t just glitches, and New York's Attorney General has confirmed how widespread this is. Beginning in 2023, the office ran a "secret shopper" survey, which are when investigators pose as patients, of the providers listed in EmblemHealth's directory. They found that the insurer had overstated the availability of in-network behavioral health providers by as much as 80%. The result was a $2.5 million settlement, including restitution to members who were pushed into paying out of pocket for care their plan supposedly covered. An earlier investigation with another insurer, MVP Health Plan, told the same story: of the 24 providers investigators called, not a single one was reachable or actually taking patients.

From then on, EmblemHealth was required to correct inaccurate listings within two business days, verify every listing every 90 days, remove providers who go inactive, and let people see out-of-network providers at in-network costs when timely care isn't available. It is also required to build a statewide plan to recruit and retain behavioral health providers. Whether those requirements translate into a directory people can actually trust is still to be determined — enforcement is ongoing and a related lawsuit brought by New York City employees is still pending.

However, this isn't only a New York problem. Federal investigators have found the same ghost networks inside Medicare Advantage and Medicaid Managed Care plans nationwide. This pattern matters because it affects vulnerable patients, those with untreated depression, anxiety, or suicidal behavior, the most. Delayed or abandoned care isn’t a joke when more than 40,000 Americans die by suicide each year. A directory that wastes someone's fragile decision to reach out can be the difference between following through and giving up.

Why ghost networks persist

Part of the reason ghost networks persist is a shortage of mental health workers. About 137 million Americans — roughly 2 in 5 — live in a federally designated mental health workforce shortage area, where only about 27% of the need is met, and psychiatrist shortages are projected to climb into the tens of thousands by 2038. The providers we have are burning out and leaving, and underserved communities are the first to lose access.

But a mental health staff shortage isn't the whole story. While plenty of therapists exist, many simply won't take insurance because of what it pays. For every dollar insurers paid primary-care doctors in Preferred Provider Organization (PPO) plans, behavioral health providers received only about 76 cents. A 2026 analysis also found that in-network medical visits were reimbursed roughly 22% higher than comparable behavioral health ones, with patients 3.5 times more likely to go out-of-network for mental health care. So where does the money go? It isn't that insurers can't afford to pay more; it’s that they hand mental health providers only a fraction of what they pay physical health care providers. In other words, the low pay isn't a limit; it's a decision.

Among psychologists who dropped insurance or never took it, 62% cited administrative challenges such as prior authorizations and audits, and 52% cited payment reliability concerns including delays in payment and refund demands. The same system that wears patients down ends up shutting out the very providers they need, leaving the people who want help with nowhere to go.

Structural stigma

This is where structural stigma comes into play, which is essentially bias baked into laws, budgets, and institutional policy. It is not one person's prejudice, but the barriers laced into decisions of how systems hand out money and attention. Lower reimbursement, narrower networks, and limited enforcement all say the same thing: that mental health is treated as though it is worth less than physical health. The Lancet Commission on stigma and discrimination frames this unequal funding and access as a health-equity failure, arguing mental health conditions deserve care as fair as physical ones. A ghost network is that unfairness made concrete: a promise the system was never funded to keep. And promises like that have a cost because for the person on the phone, a directory of names that don’t answer isn’t just inaccessible care; it’s the same as no care at all.

What we can actually do

The gap is easy to identify, but hard to close. Closing it takes (1) fair reimbursement, so networks fill with providers who'll actually see you, (2) real enforcement, because a rule nobody polices changes nothing (the value of the EmblemHealth settlement isn't the check, it's the monitor and the audits), and (3) workforce support, so the therapists we have don't burn out and quit.

None of that happens without pressure. Call your state and federal representatives and ask specifically about funding and network-adequacy enforcement, not just statements of support. And if you've hit a ghost network yourself, report it to the Pennsylvania Insurance Department at 1-877-881-6388, where staff will investigate insurers and can help get a wrongly denied claim reconsidered. Fortunately, you are not alone: the same ghost networks that make our situation feel isolating can give us leverage together. Even though it took hundreds of member complaints before regulators acted, every voice matters. Picture that person on the phone again, but imagine the list is true: every name reachable, every provider real. That's what we're advocating for. Not that we start caring about mental health, but that the system finally pays for mental health care what it’s worth.