For years we have told patients the same thing when they have trouble finding a doctor: Go to your insurance directory, look it up, they can help you.

And despite saying that, many of us have quietly known for a long time that this advice is broken. We still give it. We give it hoping for the best, knowing there really are not many other useful options to offer at this point.

And then, as expected, the patients call back. They tell us the phone numbers were disconnected. They tell us the offices said they do not take their insurance. They tell us the clinician has not worked there in years, despite the fact that the directory makes it look like they’ve been practicing there forever.

Some patients keep calling, over and over again. Many give up. Some blame themselves. Some blame me, asking why I gave them such a useless recommendation in the first place.

I’ve read similar accounts, very powerful, meaningful stories, including stories online about ghost networks. Insurance directories that promise access but deliver nothing but dead ends and frustration.

What’s new, though, is this. Now we have the profession itself going to court.

The profession goes to court

In a lawsuit filed in federal court, a leading national medical association and a state psychiatric society have sued a major health insurer, alleging that its mental health provider directory essentially amounts to a ghost network. I’ve read through it. It’s not a happy story.

This is litigation brought by physicians. It’s brought by a professional organization. And from my point of view, that matters. The lawsuit itself feels like a shift, from simply documenting harm to actually alleging deception. And it raises, at least for me, an uncomfortable question about health care more broadly. What happens when regulations fail so badly, and so completely, that doctors decide the only option left is to sue the insurance company?

That’s a compelling question. And to me, it points to just how desperate things have become.

Allegations of deception and harm

Ghost networks are often framed as a data problem. Outdated directories. Slow updates. Administrative complexity. But many of my colleagues, and to some degree I include myself here, have felt for years that the harm goes way beyond inconvenience. It risks worsening symptoms. It deepens hopelessness. It delays care. The lawsuit alleges exactly that. Patients tried to use the directory. They tried to find in-network psychiatric care. They couldn’t. As a result, many ended up paying thousands of dollars out of pocket. Others simply did not receive care at all.

There’s another allegation here that I think deserves attention. The suit claims that psychiatrists’ names and credentials were used to create the appearance of a robust network. Sometimes this meant listing clinicians who weren’t actually in the network. Sometimes clinicians who were not accepting new patients. Sometimes clinicians who worked only in inpatient settings and never provided outpatient care at all.

According to the complaint, this was not just misleading. It was harmful. You get an angry call from a patient who thinks you’re in their network. You explain that you are not. They feel rejected. Taken far enough, it can start to feel like you somehow breached a duty, like you advertised availability when you never did.

Organized medicine fights back

What makes this lawsuit different from prior ghost network cases is not just that it exists. It’s who brought it, and why. This isn’t a class action brought only by consumers. It is a professional organization asserting that its members’ identities and reputations were misused in ways that misled the public, obstructed care, and caused harm.

I’m inclined to believe that mental health care has been ground zero for ghost networks. Reimbursement has been lower. Administrative burden is higher. Out-of-network care has become increasingly common. And as a result, the consequences are often immediate and severe. But even if this starts with psychiatry, I don’t think it ends there.

If insurers are allowed to advertise network adequacy using inaccurate directories, and then benefit financially from patients’ inability to access care, it’s hard to see how this doesn’t carry over. I can’t think of a specialty that would be immune.

Ghost networks exist. That is well known. The real question is whether our current oversight mechanisms are sufficient to stop them. Up to this point, it looks like the answer has been no. And therefore, lawsuits like this are now being filed. I suspect more will follow.

Litigation is a blunt instrument. It’s a hammer. Physicians tend to prefer policy. We tend to prefer not being in courtrooms at all. But when a medical specialty decides to sue, you can’t not notice.

Whether this lawsuit succeeds or not, I think it represents a line drawn in the sand. Inaccurate access isn’t just a quality issue or an administrative glitch anymore. It’s something organized medicine is now willing to challenge, publicly and legally.

From my point of view, the gauntlet has been thrown down. The line has been drawn. And I don’t think there’s any going back.

Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. His professional profile appears on his ResearchGate profile, where additional publications and information are available.