Daria D. learned how dangerous a “ghost network” is while fearing that her son would kill himself. Daria was desperate to find a psychiatrist to help her teenage son, who was suicidal. She called more than a dozen doctors listed in her insurance company’s provider directory. Half were listed with telephone numbers that did not work. The other half said they did not take her insurance or could not see her son for at least six months. The directory was a ghost network, filled with names of doctors who did not exist, could not be contacted, did not accept the company’s insurance, or would not accept new patients. Ghost networks are a national problem. And the problem is not theoretical: Ghost networks are badly hurting patients.

Daria’s nightmare with ghost networks did not end with the grossly inaccurate directory. She then called the insurer and explained her plight. A customer service rep gave her a new list of doctors to call. But when Daria called those doctors, again all were either non-working numbers or doctors who were not in-network. Daria called the insurance company three or four times. She lost count. Repeatedly, she would be put on hold, transferred, and have to explain over and over again her son’s plight and the fact that the directory was inaccurate. Finally, a customer service rep gave her a number for an in-network provider who could actually see her son, but only if the child cut school. Finally, another customer service rep simply said there was nothing more they could do and hung up on Daria.

Daria finally found an out-of-network doctor who could help her son, at a cost of thousands of dollars, which she really could not afford. The delay in finding care prolonged his suffering and exacerbated her anxiety and depression. Happily, he is still alive and is now getting treatment, and Daria is fighting back. She is the lead plaintiff in a class-action lawsuit against the health insurer. But some patients, one sadly documented by ProPublica, are not so lucky.

Mental illnesses kill and harm millions of people each year, just as cancer, heart disease, and other physical illnesses do. Suicide is the 11th leading cause of death in the United States, and the second most common cause among people 10 to 24. Some 50,000 people take their own lives, with another 1.5 million attempting to. Mental health problems disrupt lives, destroy relationships, sideline careers, and even compromise basic activities of living, especially if they go untreated.

That is why, in 1996, Congress passed the Mental Health Parity Act, which mandates that health insurance companies cover mental illnesses just as they cover physical ailments.

Insurance companies give the impression that they are complying with these federal requirements through advertisements that hype a robust provider network and easy access to care. Without such assurances, few customers would be likely to choose a plan that admitted it had barely any providers in the network. But the reality is much different. Approximately half the people who seek mental health care, and are entitled to it through their insurance plan, cannot get it because their insurance companies are utilizing ghost networks.

In the last six months my law firm has conducted 45 secret shopper studies of a dozen different insurance plans across the country. The best performing plan published a directory that was only 54 percent fake; the worst were 100 percent in error. Overall, about 80 percent of the plans surveyed had ghost rates of 80 percent fake listings or worse. A doctor was considered a ghost if they could not be reached after three attempts, did not actually take the insurance, or were not accepting new patients.

We did not conduct these secret shopper studies in a vacuum. Rather, they were efforts to replicate the experiences of Daria and many other people who had tried to get mental health services for themselves or their children, with no success. Our findings were echoed by the Office of the New York State Attorney General, which did its own secret shopper surveys of the ten largest insurers in New York State. That study too found that the best plan was 85 percent wrong and the worst were 100 percent completely inaccurate.

Another reason some health insurers publish grossly inaccurate directories is not hard to infer: company profitability. The demand for mental health services is large and growing, and the cost of providing it is expensive. People are seeking mental health care at a much higher rate today than even just a few years ago. In 1999, only about 7 percent of the population sought mental health care. By 2019, that had grown to 19 percent. But the biggest surge came during, and many experts believe because of, COVID; and in 2024 it was 23.4 percent. Plus, more than twice that number say they would utilize mental health services if they could find providers participating in their insurance plan.

The problem is further aggravated because the demand side for mental health services is out of sync with the supply side: Many health insurance companies simply do not want to pay providers the rates they are seeking. For example, in New York City, the going rate for a child psychiatrist is usually between $450 and $750 per hour, with the average about $650 per hour. But doctors report that several leading insurance companies are willing to pay only between $80 and $250 per hour. For psychologists, therapists, and social workers the hourly charges are lower, typically between $200 and $300 per hour. And the insurance companies typically pay their in-network providers between $60 and $80. Not surprisingly, because the demand for care far exceeds the supply of qualified doctors, many providers choose to remain out of network and work only with patients who are able to pay their standard rates out of pocket.

Unlike other medical specialties where doctors routinely see several patients at the same time, moving from exam room to exam room, and billing the insurance company for multiple procedures in the same hour, therapists and psychiatrists cannot do that. Their attention and care must be devoted to a single patient in any given billable hour. At the rates insurance companies want to pay, many mental health providers have trouble covering their overhead, much less paying back their student loans and making a profit.

Figuring out a fair and affordable payment schedule for providers will not be easy. It will undoubtedly cost insurance companies more than what they want to pay, and it will also be less than what providers think is fair. But in the meantime, the Daria D.’s and their children should not suffer unnecessarily because of ghost networks. This part is an easy fix: Insurance companies have to stop lying about who is in their network. Just tell the truth.

Steve Cohen is an attorney whose practice epitomizes the intersection of law, policy, and journalism, with the realities of politics thrown in for good measure. For 35 years before going to law school, he was a successful publishing executive, including at Time and Scholastic, a best-selling author, and the CEO of three internet start-ups.

Since teaming up with Adam Pollock in 2018, Steve has learned to bring that unusual background, diversity of experience, and skills to the law. He can be reached on LinkedIn.