A secret shopper study found less than a quarter of calls to mental health clinicians resulted in appointments, with directory errors and unreachable providers driving so-called “ghost” networks.

The study, published Friday in JAMA Health Forum, analyzed calls to psychiatrists and psychologists listed in the directories of the largest commercial carriers in five states — Delaware, Montana, New Jersey, Rhode Island and Virginia. Calls were made based on the closest listed clinician for a simulated patient in a standard preferred provider organization plan.

These calls uncovered widespread ghost networks in commercial insurers' provider networks, which cover most insured U.S. residents.

Unanswered calls for ambiguous reasons, like a busy signal or generic voicemail, were the primary contributor to ghost networks in the study. However, 56% of the calls deemed evaluable by the researchers because they were picked up or outright disconnected uncovered inaccuracies in the provider directories.

Errors in mental health clinicians’ contact information was the most common type of inaccuracy, including about 22% of calls revealing specialty errors. In 11% of calls, the numbers were either disconnected or out-of-service, which indicated a direct, verifiable sign that directory information was wrong. In contrast, unanswered calls because of a busy signal or that continued to ring without a pickup left researchers unable to verify if direction information was correct.

The researchers also noted 1.6% of calls with network status errors, such as a clinician no longer being active in the network.

Another 1 in 5 evaluable calls were affected by capacity limitations, including a clinician not accepting new patients or not having appointment availability.

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