'Ghost networks': How insurance errors endanger California patients

"Kuhn had a massive hiatal hernia that required surgery. Her entire stomach had pushed into her chest cavity through an opening in the diaphragm, a muscle that divides the torso, and was wrapped around itself. In the crowded space, her esophagus was bent and twisted. If the entwined organs kept rotating further, they could cut off their own blood supply."

"Ghost networks are a longstanding problem in California that advocates and lawmakers have tried to fix for more than a decade. Patients searching for primary care, physical or mental health therapy or specialty care discover that the lists of in-network providers published by insurance companies are frequently inaccurate or outdated - by some estimates a third or more of these listings may be inaccurate. Phone numbers and addresses may be wrong. Most frustrating is when listed providers no longer contract with a patient's insurance company."

"'We've been hearing for years from consumers, stories about how hard it is to find a provider,' said Katie Van Deynze, a lobbyist with Health Access California, a consumer advocacy group that has worked to improve provider directories. But insurers and providers oppose efforts to further regulate directories and blame each other for inaccuracies. Kuhn's primary care physician referred her to a cardiothoracic surgeon in Walnut Creek."

Mary Kuhn presented with chest and jaw pain and tongue numbness and was later diagnosed with a massive hiatal hernia that required surgery. Her stomach had pushed into her chest, twisted around itself, and threatened to cut off blood supply to nearby organs. While searching for a specialist, Kuhn encountered inaccurate insurer provider listings that did not reflect who actually accepted her insurance. Ghost networks in California leave patients facing wrong contact information, outdated addresses, and providers no longer under contract. Insurers and providers clash over responsibility while advocates seek directory improvements.

Read at The Mercury News