Elgin Nelson
Assemblymember Chris Holden, California’s District 41 representative, passed legislation that would put an end to “ghost networks” and rampant healthcare provider inaccuracies.
Recent studies have found that some health plans have inaccuracy rates as high as 80%, and major plans such as Anthem and Kaiser, have inaccurate information for 20% to 38% of providers. These inaccurate lists produced are referred to as “ghost networks,” because they do not exist.
“Ghost networks should not be something we accept as reality,” said Assemblymember Chris Holden. “The issue here is not the quality or the cost of care, but the actual access. This bill provides solutions for Californians struggling to find their unique care needs by making the information given to them accurate and accessible.”
Under existing law, directories are required to include the basic information of each provider, as well as provide regular updates and annual reviews. The law also provides that health plans will pay for out-of-network care if a consumer relies on a directory to receive said care.
Despite this, compliance with said law is unbelievably low. The responsibility of sorting through these inaccurate lists falls to the consumer. For many, this means sifting through directories to find care, calling provider after provider, only to be told the provider is no longer in-network, no longer accepting new patients, or even no longer in practice.
This is especially harmful to those already suffering from health care inequity, such as those with limited English proficiency and persons with disabilities. Ghost networks contribute to inequity in health care by leaving many Californians to fend for themselves in their most vulnerable time.
“Provider directories are meant to help consumers find care and shop for a health plan, but many consumers have had care delayed because they have to sift through listings that are grossly inaccurate,” said Katie Van Deynze, policy and legislative advocate with Health Access California, the sponsor of the bill. “AB 236 puts benchmarks and policies in place to get our state to accurate health plan provider directories so that Californians can access the services that they need. This is a critical bill to breaking down barriers to care, and we applaud the Assembly for passing this bill to the Senate.”
AB 236 will now require the Department of Managed Health Care and the Department of Insurance to develop uniform provider directory standards, as well as create a process to re-add providers who have been removed from the directory. The bill will also mandate health plans to perform regular updates and an annual review of their directories.
The legislation, if passed through the Senate, has plans to provide 60% accuracy by July 1, 2025, 80% accuracy by July 1, 2026, 90% accuracy by July 1, 2027, and finally, 95% accuracy by July 1, 2028.
“Health is an important facet to help our communities thrive,” said Holden. “Affordable, accessible, and quality care for all Californians is what we want.”