Few mental health appointments available quickly

A study appearing in the JAMA Health Forum revealed that roughly one in eight attempts to schedule appointments with mental health professionals, identified through commercial insurer directories, successfully connected callers to available slots. Conducted by researchers, the analysis involved 5,822 calls placed to psychiatrists and psychologists affiliated with major insurers in Delaware, Montana, New Jersey, Rhode Island, and Virginia between October 2025 and March 2026.

Out of all calls, only 12.4% resulted in securing an appointment. Among the 2,252 calls with clear outcomes, 55.6% encountered errors in directory listings, while 23.6% successfully booked with the advertised clinician. Meanwhile, 21.6% faced provider capacity limitations. The average wait time for confirmed appointments stood at 20.5 days. Researchers highlighted that the process from directory lookup to actual care often fails, calling the obstacles “systemic and pervasive.”

The investigation covered 5,822 calls across the five states, though 3,570, or 61.3%, were classified as unusable. The primary issue was callers reaching only voicemail or automated systems without human interaction options.

Funding for the research came from Inseparable, a national advocacy group focused on mental health. Under the No Surprises Act, the U.S. Centers for Medicare & Medicaid Services mandates that insurers verify and refresh directory data at least every 90 days, updating records within two business days of provider-submitted changes. If patients receive out-of-network care due to incorrect listings, plans cannot charge more than in-network rates, and those payments must apply toward in-network deductibles and out-of-pocket limits.

In February, New York Attorney General Letitia James announced a $2.5 million settlement with EmblemHealth, requiring penalties, restitution for members, and independent oversight. The agreement followed findings that over 80% of behavioral health providers listed as accepting new patients were unavailable. The settlement also mandates regular mystery-shopper audits, public transparency, complaint tracking, and a provider recruitment strategy. Additionally, it guarantees out-of-network care at in-network cost-sharing rates when in-network appointments are inaccessible.

Federal oversight is intensifying, particularly in Medicare Advantage programs. A October 16 proposal for the 2028 contract year from CMS would require plans to validate directory accuracy every 90 days and publish performance scores. The agency also proposed protecting members from higher cost-sharing when relying on flawed listings.

This challenge has persisted for years. A lawsuit filed in October 2024 accused Anthem Blue Cross Blue Shield of New York of operating a “ghost network,” alleging that inaccurate provider listings delayed mental health treatment and forced patients into costly out-of-network options. As CMS moves to address these failures, the effectiveness of its interventions remains under close examination.