AB 236 (Holden) Ensuring Accurate Health Plan Provider Directories

Every health plan in California is required to maintain an updated list of in-network health care providers to their enrollees. These include doctors, mental health professionals, hospitals, labs, imaging centers, and more. When consumers go to search for a new doctor or mental health specialist, they must be able to rely on these “provider directories” for accurate information. 

When the providers on these lists are unreachable or do not actually provide care to consumers covered by that health plan, this is sometimes referred to as a “ghost network.” Ghost networks lead to confusion among consumers who may have their care denied or delayed. Consumers may even feel forced to seek necessary care out-of-network and pay inflated rates for care. In one case, a consumer seeking help called 73 doctors and found that some had retired, others were not accepting their insurance, some had disconnected phone numbers, and a few had passed away. These inaccuracies and ghost networks have the greatest impact on consumers who already face the worst access such as those with limited English proficiency, persons with disabilities, and others in marginalized communities thus worsening inequities in health care.