Assemblymember Holden Announces Solution to Ghost Networks

Sacramento, CA – Today, Assemblymember Chris Holden introduced AB 236, legislation that would put an end to “ghost networks” and rampant provider inaccuracies by reinforcing current policy with accuracy guidelines, benchmark goals, and effective enforcement methods.

“Ghost networks should not be something we accept as reality,” said Assemblymember Chris Holden. “The issue here is not the quality or the cost of care, but the actual access. This bill provides solutions for Californians struggling to find their unique care needs by making the information given to them accurate and accessible.”

California has one of the nation’s strongest laws on health plan provider directories. Existing law provides that health plans would pay for out-of-network care if a consumer relied on a directory to receive said care. Recent studies have found that some health plans have inaccuracy rates as high as 80%, and major plans like, Anthem and Kaiser, have inaccurate information for 20% to 38% of providers. As a result, the inaccurate lists produced are referred to as “ghost networks,” because they do not actually exist.

“If a health plan’s provider directory is not up-to-date, someone may end up paying more for their care, or not be able to access proper care at all,” said Jose Torres Casillas, policy advocate for Health Access California, the statewide health consumer advocacy coalition. “Improving compliance laws are a key way that the state can ensure that these directories are accurate. We thank Assemblymember Holden for introducing AB 236 to ensure that these directories are audited regularly so California health consumers can have faith that they are getting the best information possible to make decisions for their care.”

Though our state has regulations in place for provider directories, consumer protections are not effectively enforced. The Department of Managed Health Care has only taken five enforcement actions, all with small fines. For many health plans, there is little incentive to abide by existing law given the infrequency and insignificance of fines imposed. AB 236 would work alongside medical providers to incentivize compliance and would ensure that the information provided to enrollees are accurate.

Specifically, the bill would establish the following numeric percentage accuracy benchmarks for plans: 60% accuracy by January 1, 2024; 80% accuracy by January 1, 2025, and so on. AB 236 would also require annual audits and verification by health plans of provider directories for accuracy of all required information.

“Health is an important facet to help our communities thrive,” said Assemblymember Chris Holden. “Affordable, accessible and quality care for all Californians is what we want.”

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