Ghost Networks in Behavioral Health: How to Appeal When Your Insurer's Directory Is Misleading

What is a ghost network — and how common is it?

The term “ghost network” describes an insurer's provider directory that is inaccurate in ways that systematically obstruct access to care. A provider is effectively a ghost in the directory if any of the following is true at the time a member calls: the provider is no longer contracted with the plan; the provider is no longer accepting new patients; the phone number is wrong or disconnected; the provider has retired or moved; or calls go unanswered with no callback after multiple attempts.

These problems are common in every insurance market. They are disproportionately severe in behavioral health. The EmblemHealth investigation, conducted in 2025 and resolved by the New York Attorney General on February 19, 2026, is the most concrete public measurement to date: New York investigators called providers listed in EmblemHealth's behavioral health directory as accepting new patients and found that more than 80% were effectively unavailable. The insurer was required to pay $2.5 million in penalties and implement sweeping reforms, including restitution to members who had paid out-of-network rates because they could not access a functional in-network provider.

EmblemHealth is not an outlier. The DOL's 2025 MHPAEA Report to Congress, released on March 3, 2026, reviewed enforcement activity from August 2023 through July 2025 and found network composition failures — specifically, insufficient numbers of in-network MH/SUD providers — to be one of the most consistently observed parity problems across all plan types audited. The report also found that plans were routinely increasing reimbursement rates to attract and retain medical/surgical providers while failing to apply the same strategy to behavioral health networks where gaps had been identified.

Why a ghost network is a MHPAEA violation

Mental health parity law does not only regulate visit limits and dollar caps. It also governs any non-quantitative treatment limitation — an NQTL — that affects how members access covered services. Under the 2013 MHPAEA implementing regulations at 29 CFR § 2590.712(c), network composition standards are explicitly classified as NQTLs. A plan cannot apply NQTL practices more restrictively to mental health or substance use disorder benefits than to substantially all analogous medical/surgical benefits.

When a behavioral health network is functionally empty while the plan's medical/surgical network is fully accessible, that asymmetry is a parity violation. The plan is, in practice, applying a much more restrictive access standard to mental health care. Members who cannot find an in-network behavioral health provider face higher out-of-pocket costs, longer wait times, or no care at all — none of which they would face if seeking, say, outpatient orthopedic care or dermatology.

The DOL's 2025 Report framed this gap in explicitly financial terms: plans were paying higher reimbursement rates to attract and retain medical/surgical specialists while declining to do the same for behavioral health providers, even after identifying behavioral health network shortfalls in their own analyses. That pattern — documenting a gap and then not fixing it — is the definition of a non-compliant NQTL under 29 CFR § 2590.712.

The CAA 2021 § 203 disclosure duty applies here too. Any plan subject to MHPAEA must produce, on written request, a comparative analysis of each NQTL applied to behavioral health — including the methodology used to build and maintain the provider network. If the plan's own methodology does not require the same recruitment and retention investment for behavioral health as for medical/surgical specialties, that methodology cannot survive scrutiny.

How to document a ghost network: a practical call log

Before you can appeal on ghost-network grounds, you need written evidence that the in-network directory does not actually provide access to care. The method is straightforward: call every provider the insurer lists as in-network and accepting new patients within a reasonable geographic range, document each call, and compile the results.

Courts and regulators have accepted call logs as primary evidence in ghost-network cases. The New York AG investigation that produced the EmblemHealth settlement used exactly this methodology. You do not need an attorney to do this. You need a phone, a spreadsheet, and persistence.

Keep one row per call attempt. Capture at minimum:

Call at least five providers before submitting the log. Ten is better. The pattern — not any single call — is the evidence. Save the spreadsheet as a PDF and attach it to every appeal submission.

What the appeal letter should say

Once you have the call log, the appeal has three parts. Each one does a specific job; none of them should be optional.

Part 1 — State the parity claim directly. Open with a plain statement that the denial is being appealed on MHPAEA grounds. Name the regulation: “This appeal asserts that the denial of out-of-network benefits constitutes a non-quantitative treatment limitation in violation of the Mental Health Parity and Addiction Equity Act of 2008, 29 U.S.C. § 1185a, and the 2013 implementing regulations at 29 CFR § 2590.712(c), because the plan's in-network behavioral health provider network is not functionally accessible as required by parity law.”

Part 2 — Attach and cite the call log. Submit the call log as Exhibit A. In the letter body, summarize it: “Enclosed as Exhibit A is a documented call log reflecting attempts to reach [X] in-network behavioral health providers listed in the plan's directory as accepting new patients in [patient's county/zip area] as of [date range]. [X of X] providers were unavailable. The specific outcomes are documented by provider, date, and call result.”

Part 3 — Issue the CAA 2021 § 203 demand. Under the Consolidated Appropriations Act of 2021, codified at 29 U.S.C. § 1185a(a)(8), the plan is required to produce a written comparative analysis of any non-quantitative treatment limitation applied to behavioral health benefits. Network composition standards are an NQTL. The appeal letter should request this analysis:

Pursuant to § 203 of the Consolidated Appropriations Act of 2021, 29 U.S.C. § 1185a(a)(8), I am requesting the plan's written comparative analysis of the network composition standards applied to behavioral health and substance use disorder providers, including the factors evaluated, the methodology used, and the data reviewed when determining whether the behavioral health network is comparable in access to the plan's medical/surgical specialist network. Please respond within 30 days.

If the plan denies the appeal or fails to produce the comparative analysis, you have two escalation paths: a complaint to your state Department of Insurance (for fully-insured plans) or a complaint to DOL's EBSA (for ERISA self-funded plans). Reference the MHPAEA appeals guide for specific escalation language. For state-by-state regulator contacts, see the per-state appeal guides.

What solo therapists need to know about their own directory listings

Ghost networks are not only a patient problem. Solo therapists are frequently left in directories long after leaving a panel. A provider who resigned from a plan two years ago may still appear in that plan's online directory today. This creates two separate risks.

Unwanted patient contact. Patients call you expecting in-network care and are surprised to learn you're out-of-network. This wastes time for both of you and can damage the referral relationship if the patient feels misled by the insurer.

Patient appeals that name you inaccurately. If a patient is denied OON coverage and the insurer defends by pointing to “available” providers — including you — while you have documentation showing you left the panel, that documentation is useful evidence for the patient's appeal. Share it (with appropriate privacy protections) if asked.

To remove yourself from a directory: send a termination-of-participation letter to the plan's provider relations department by certified mail, retain the return receipt, and follow up in writing if your listing has not been updated within 60 days. Document everything. Several state laws now require plans to update their directories within a specified timeframe — check the New York state appeal guide and California state appeal guide for state-specific directory-accuracy requirements.

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