ACA network regulatory filings are inaccurate, poorly match provider directories

Am J Manag Care. 2025 Sep 1;31(9):e265-e269. doi: 10.37765/ajmc.2025.89791.

ABSTRACT

OBJECTIVES: Access to mental health services has been shown to be particularly inadequate, with limited understanding of the efficacy of existing network adequacy regulations. State and federal regulations mandate insurance carriers to submit regulatory filings to help maintain network adequacy compliance, but the accuracy of these data remains unassessed.

STUDY DESIGN: We employed a secret shopper survey to verify regulatory filings and assess the congruence between the filings and provider directory listings as well as appointment availability and wait time for 8306 mental health counselors submitted by all carriers participating in Pennsylvania’s Affordable Care Act (ACA) Marketplace for plan year 2024.

METHODS: Descriptive analyses, with tests of proportion and t tests to assess differences between carriers and between adult and pediatric provider specialties.

RESULTS: A total of 19.9% of filed regulatory listings (n = 1649) were not present in consumer-facing provider directories, and only 35.3% of filed listings (n = 2928) fully matched provider directory entries. Of the 2152 provider listings we were able to verify fully via secret shopper calls, 65.2% (n = 1404) exhibited at least 1 inaccuracy. Inaccurate phone number was the most common issue (56.6%; n = 1219). Appointments were available for only 321 of the 2152 providers (14.9%), with a mean of 33.2 days lapsed between call and scheduled appointment time. Although we identified substantial differences in appointment wait times by carrier, we found no difference between adult and pediatric providers.

CONCLUSIONS: ACA network adequacy assessments that rely on carrier regulatory filings and/or consumer-facing directories substantially overestimated provider availability and access to mental health services.

PMID:40966601 | DOI:10.37765/ajmc.2025.89791