Licensed therapist Sarah Soroken has frequently heard from her patients about the difficulty of finding a mental health provider who accepts their insurance. One case she highlighted was particularly alarming. While working at Kaiser’s Vallejo Medical Center in 2022, Soroken recounted a college-aged woman who ended up in the emergency room after attempting suicide. The patient had reached out to 50 mental health providers listed as accepting Kaiser insurance, but none were available or actually took her insurance.

“This patient now faces the trauma of a suicide attempt and additional harm caused by our healthcare system,” Soroken testified to the Senate Health Committee earlier this month.

Though Soroken is no longer with Kaiser, she supported Assemblymember Chris Holden’s Assembly Bill 236, which seeks to give state regulators the authority to fine insurers for having inaccurate and outdated provider lists. This bill, aimed at addressing the issue of “ghost networks,” has passed both the Assembly and the Senate Health Committees, with opposition only from Republicans. The bill has faced strong resistance from California’s influential doctors and insurers, who argue it is unnecessary and burdensome. They also blame each other for inaccuracies in the directories, despite having collectively donated $4.7 million to California legislators since 2015.

The bill's potential costs have also raised concerns. The Department of Managed Health Care estimates it would require $12 million to hire additional staff to enforce the new regulations. This estimate, which represents the cost of around 80 employees, could be a significant concern for the state's budget team and lawmakers.

The Department of Managed Health Care has not clarified the details behind its cost estimate, though it indicated that the figure might be outdated due to recent amendments to the bill.

Ken Cooley, a former Assembly member, speculated that the department might have inflated the cost estimate to argue against the bill. Nevertheless, he acknowledged the importance of accurate provider lists for consumers' well-being.

The bill’s author, Chris Holden, did not respond to interview requests but has noted that existing laws since 2015 have failed to ensure accurate provider directories, leading to significant inaccuracies. Recent studies have shown that some smaller health plans have up to 80% inaccuracy rates, with major plans having inaccuracies between 20% and 38%.

Holden’s bill would require provider directories to be at least 60% accurate by next year and 95% accurate by July 1, 2028. Insurers could face fines of up to $10,000 per 1,000 enrolled customers annually if they fail to meet these benchmarks. The bill also stipulates that patients who use out-of-network providers due to directory inaccuracies cannot be charged out-of-network rates.

Insurers and doctors have expressed opposition to the bill. Insurers argue that doctors are responsible for maintaining accurate records, while doctors believe insurers should bear the responsibility. Concerns include potential cost shifts to doctors and the impact on out-of-network payments.

Soroken emphasized the need for accurate provider lists, particularly for vulnerable patients. She argued that failing to ensure this accuracy would be negligent and detrimental to patient care.

Kaiser Permanente has not taken a formal stance on the bill and declined to comment on Soroken’s testimony. The organization has faced scrutiny for delays in mental health care and recently settled a $200 million lawsuit related to its behavioral health system. Kaiser has also faced strikes from mental health workers over high caseloads and working conditions.