Having insurance doesn’t mean you can get a mental health appointment

Americans with commercial insurance are generally told they have access to a strong network of mental health providers. But when researchers called providers listed in those networks, securing an appointment was usually difficult or impossible, according to a new study.

Researchers, posing as “secret shoppers” looking for appointments for issues including anxiety and grief, called 5,822 psychiatrists and psychologists on commercial provider lists in five states—Delaware, Montana, New Jersey, Rhode Island and Virginia.

Their aim was to test whether the provider information in insurance directories actually connected patients with available, in-network mental health professionals.

A successful call (meaning someone picked up the phone) resulted in an appointment with the health care provider only 24% of the time. If the caller was willing to see another clinician, an appointment could be made 31% of the time.

The research, led by Simon Haeder and Wendy Xu of The Ohio State University College of Public Health, appears today in JAMA Health Forum.

“Access to mental health care in the U.S. is a well-documented struggle. This shows that even those with private insurance, who are told they have many providers to choose from, can have a hard time getting the care they need,” Haeder said.

The researchers couldn’t analyze more than six in 10 calls because they reached an automated system or answering machine and could not speak with a person.

When analyzing the remaining 2,252 calls, Haeder and his colleagues found:

• In 56% of calls, provider directory information was inaccurate.
• In 22% of calls, capacity limitations, including providers not accepting new patients, prevented an appointment.
• Callers were told they’d have to wait an average of 20.5 days for care, with longer waits for psychiatry than psychology.

“Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes aren’t always reflected in insurance directories,” Haeder said.

Insurers may also list clinicians who are part of a contracted group even when those individual clinicians aren’t actually available. Researchers describe these as “ghost” providers or networks because they appear to exist on paper but aren’t necessarily accessible to patients.

“Our study speaks to a broader problem in American health care: the disconnect between having health insurance and actually being able to use it,” said Xu, an Ohio State professor of health services management and policy.

“Inaccurate provider directories are not simply an administrative inconvenience. They can create substantial barriers to care, leaving people effectively underinsured despite having insurance.”

Challenges with provider network directories have been documented across health care and are especially worrisome when it comes to people looking for help with mental health concerns, the researchers said.

“Seeking help can already be difficult for someone experiencing anxiety, grief or another mental health concern, and that’s exacerbated when they’re running into answering machines, unavailable providers and ‘in-network’ psychologists who’ve moved to another state,” Haeder said.

Provider-directory accuracy is a longstanding, systemic problem across specialties, with its roots in several challenges, including inconsistent regulation and enforcement and incentives for insurers to beef up provider lists, he said.

“I’d love to see a centralized provider directory that clinicians maintain and insurers can access, rather than every insurer separately trying to maintain its own database,” Haeder said.

Other researchers who worked on the study are Ohio State doctoral student Yuqin Lou and Benjamin Miller of Stanford University.

Who’s behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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