The Rise of Ghost Therapists: Outdated Mental Health Directories Make It Harder to Find Help

More Americans are seeking out therapists, but finding a provider is an arduous process, made more difficult by outdated insurer directories. Dozens of phone calls to providers often yield no response, and would-be patients are discouraged from finding help.

In a recent investigation, The Seattle Times contacted 400 therapists from Premera Blue Cross, Regence BlueShield, UnitedHealthcare, and Molina Healthcare directories across different Seattle ZIP codes. Only 32 of the 400 therapists confirmed openings. Of that group, 13 required a referral.

For those with health insurance who can afford therapy, simply finding a provider to begin that journey can be a monumental hurdle.

Thirty-eight therapists told The Seattle Times they weren’t accepting new patients, but in many cases, providers didn’t respond, effectively ghosting the paper. The problem with “ghost therapists” isn’t new, but it’s growing.

More Americans are seeing therapists (if they can find one)

The right treatment can be life-changing for people struggling with mental health, according to the mental health nonprofit To Write Love On Her Arms (TWLOHA). Briauna Hagins, program manager for TWLOHA’s provider directory, has heard from numerous scholarship recipients who received three to six months of mental healthcare paid for by TWHOLA. 

One scholarship recipient, “25 years deep into an abusive relationship,” credits therapy with saving her life and keeping her “grounded and healthy for myself and my four kids.” 

“I know there is no destination with therapy. It’s truly a journey, but today, I am a different woman than I was a year ago. I am still meeting with my therapist weekly and receiving help and healing every time,” said the recipient in an impact statement.

In a 2014 study published by the American Psychiatric Association (APA), investigators called 360 psychiatrists from Blue Cross Blue Shield’s directory. The researchers secured appointments with 93 psychiatrists (26%) but also came across phone numbers for a McDonald’s, a boutique, and a jewelry store.

Almost a decade later, Americans’ mental health is the poorest it’s been in more than two decades of Gallup polling. Nearly a quarter of U.S. adults described their mental health as “only fair” or “poor” in 2022. Twenty-three percent saw a mental health professional last year — up from 13% when Gallup last asked the question in 2004.

Exorcizing ghost therapists

Legislators are trying to reduce outdated directory listings. Earlier this year, Sen. Ron Wyden (D-OR) conducted a study similar to The Seattle Times’ investigation. Wyden’s staff called 120 providers across 12 insurer directories in six states. Wyden’s staff could only make appointments 18% of the time.

Wyden has co-sponsored two bills to address ghost directories. The Behavioral Health Network and Directory Improvement Act of 2022 stalled after introduction in the Senate. A committee will determine if The Better Mental Health Care for Americans Act, introduced in March 2023, moves forward to the House or Senate.

Congress did approve the No Surprises Act, which requires insurers to update directories every 90 days, in 2020. In the same year, the city of San Diego sued Kaiser Permanente, Molina, and HealthNet, alleging the insurers misled customers with ghost networks. All three insurers had faced lawsuits for inaccurate directories before.

Insurance companies trying to clean up directories face a Herculean task. Provider availability changes from day to day. Without the ability to edit their own listings, therapists need to reach out to insurance companies, fill out a form, and send it back to insurers, which then update the site.

Gathering accurate information involves regular emails, phone calls, and faxes (yes, faxes) to busy providers trying to respond to multiple insurers between patients, Regence and Premera told The Seattle Times. Spokespeople from both companies said they would support a national directory allowing providers to update their information in one place.

Alternatives to insurer ghost directories

People who can’t find therapists through insurer directories may have better luck with other resources. Psychology Today’s Find a Therapist tool has an insurance filter, and ZocDoc shows real-time availability of covered providers with the option to book online.

A growing number of telehealth companies provide additional options. While some sites, like BetterHelp, don’t accept insurance, reasonably affordable subscription-based models appeal to patients who are tired of getting ghosted.

Mental health organizations are also stepping up to connect patients with providers. The National Alliance on Mental Illness (NAMI) lists local support groups on chapter pages, and the mental health nonprofit TWLOHA maintains a FIND HELP directory with more than 230,000 providers. Hagins says user feedback helps the organization maintain its directory.

“The FIND HELP team regularly uses our tool and will routinely check for any discrepancies or links that are no longer active. There is also a suggestion button on each listing to recommend changes to programs. For example, if you see a program that you know is no longer in operation, you can make that suggestion,” says Hagins.

Like Psychology Today, providers in TWLOHA’s directory can claim listings and update their availability.

What's next

Fixing outdated directories is complicated, but the rising number of Americans seeking mental health services could drive more insurance companies to keep listings current. If potential legal consequences aren’t enough motivation to banish ghost listings, competition from user-friendly telehealth sites may draw therapists away from networks, taking their patients with them.