Study: Calling Insurance-Listed Therapists Rarely Yields An Appointment

Therapists Listed by Insurers Often Can’t Be Reached or Booked

Someone finally works up the nerve to ask for help. They pull up their insurance company’s list of covered therapists and start dialing. A disconnected number. A voicemail greeting with no person behind it. An office that isn’t taking new patients. By the time anyone reaches a real person who can offer an appointment, the search has turned into a job of its own.

A new study in JAMA Health Forum puts numbers on that frustration, and the numbers are rough. Researchers made nearly 6,000 calls to psychiatrists and psychologists listed in the official directories of the biggest private insurers in five states. The question was simple: if a patient follows the directory as intended, calls the nearest listed clinician, and asks for a first appointment, does it work?

Mostly, it didn’t. Across all calls, only 12.4% ended with an appointment offered, whether by the listed clinician or someone else at the same number. A patient who dials once, as the callers did, came up empty roughly seven out of eight times. Directories packed with clinicians who can’t be reached or booked are known as ghost networks, and the results show that private insurance, long assumed to offer smoother access than public programs like Medicaid, has them too.

Secret Callers Tested Insurance Therapist Appointment Access in Five States

Research assistants posed as relatives seeking care for a family member. Each caller received a made-up patient profile with a name, home address, insurance plan, and a nonemergency mental health condition. Using the insurer’s own online directory, each caller then found the closest psychiatrist or psychologist covered by the plan and asked for the soonest opening. Callers checked whether an appointment was available but never booked one.

Calls ran from October 2025 through March 2026 in Delaware, Montana, New Jersey, Rhode Island, and Virginia. Researchers chose the largest private insurers in each state, all Blue Cross Blue Shield affiliates, reasoning that if the biggest companies cannot keep directories accurate, smaller ones likely fare worse.

More than 60% of the 5,822 calls, 3,570, never produced a usable answer. Most reached only an answering machine or an automated system with no human on the line. Researchers set those aside because the cause was unclear. That left 2,252 usable calls, meaning the caller either reached office staff or got a disconnected or out-of-service message.

Directory Errors Hit Over Half of Insurance Therapist Calls With a Usable Answer

Among usable calls, 23.6% resulted in an appointment with the specific clinician listed. Counting another clinician at the same number raised that to 32.1%, which still left roughly two out of three usable calls with nothing.

Directory errors were the biggest obstacle, turning up in 55.6% of usable calls. Bad contact information accounted for 31%, including 257 calls that reached a disconnected or out-of-service number. Another 22.2% reached a clinician whose listed specialty was wrong, such as a listed psychiatrist who no longer practices psychiatry.

Full schedules were a separate barrier. In 21.6% of usable calls, the clinician was not taking new patients or offering appointments, a figure that rose to 25.2% for psychologists.

When an appointment came with a specific date, the average wait was 20.5 days, longer for psychiatry (22.5 days) than psychology (17.3 days). Travel time, measured only when an appointment was offered, averaged 17.1 minutes but climbed to 41.8 minutes in Montana and 30.8 minutes for rural residents, more than double the 12.7 minutes for nonrural residents.

Even the best-performing insurer, in New Jersey, secured an appointment with the originally listed clinician on fewer than one in three usable calls. No insurer or state came close to reliable access.

Disconnected Numbers Persist More Than Three Years After a Federal Directory Rule

A federal law, the No Surprises Act, requires insurers to verify and update provider directories at least every 90 days, and it has been in effect for more than three years. Dead numbers, the authors note, cannot be blamed on staffing or on how a practice handles calls, and catching them is exactly what that check was meant to do.

Staffing likely explains part of the unanswered calls. Many mental health clinicians work in solo or small practices without front-desk staff, which may make them harder to reach. The authors argue that rules designed around medical practices with administrative teams may be a poor fit for mental health care, and they suggest regulators consider audits of directories rather than insurers’ own reports.

Failed searches carry a cost beyond frustration. The authors warn that when referrals fall through, untreated illness and crisis care use may rise, and primary care doctors can end up managing psychiatric conditions beyond their training.

For the person searching, the cause matters less than the result: a provider who exists on paper but not in practice. A listing that sends a patient who finally worked up the nerve to call into a dead end is not access to care. Among the largest insurers in five states, that was the typical result of a single call.

---

Disclaimer: This article reports on a single research study and is for informational purposes only. It is not medical, insurance, or legal advice. Anyone with questions about mental health care should consult a qualified professional.

---