“Ghost Networks” and Medicare Advantage

Why You Need an Advocate by Your Side

Imagine this: you’re frantically searching for a doctor to help with a health issue that’s keeping you up at night. You search through your Medicare Advantage plan’s provider list online, call number after number, only to hear, “Sorry, we don’t take that plan,” or worse, “That doctor hasn’t worked here in years.” Your plan’s network is supposed to have your back, but it feels like chasing a ghost.

This isn’t just a hypothetical—it’s a heartbreaking reality for too many. Take the story of Ravi Coutinho, a 36-year-old Arizona man who died after struggling to find a mental health provider through his Ambetter plan, run by Centene Corporation. His mother, Barbara Webber, filed a wrongful death lawsuit on May 23, 2025, in Maricopa County, claiming Centene’s inaccurate provider lists—sometimes referred to as “ghost networks”—left Ravi without the care he desperately needed. Despite making 21 calls to Ambetter in early 2023, Ravi couldn’t find an in-network therapist, and his death was ruled accidental, likely tied to complications from excessive alcohol use.

Here’s the thing: when you call your insurance company’s helpline, the person on the other end might explain how your plan works, but they won’t tell you about your rights. And you have some powerful ones.

If your Medicare Advantage plan’s network is letting you down—meaning you can’t find a doctor, surgeon, or therapist to meet your needs—you’re not stuck. Federal rules say your plan must cover medically necessary care from an out-of-network provider at the same cost (copays or coinsurance) you’d pay in-network. This isn’t just a nice gesture—it’s the law, backed by the Centers for Medicare & Medicaid Services (CMS). It’s there to make sure you’re not left high and dry when your plan’s network falls short.

But here’s the catch: most people don’t even know this right exists. They don’t know who to call, what to say, or how to push back when the insurance company drags its feet. That’s where the system can feel like a maze, and too many people get lost in it.

That’s why having an agent in your corner is a game-changer.

When one of my clients calls me saying, “The insurance company says I can’t get the service or see the doctor I need.” I don’t just sympathize—I roll up my sleeves. I help them request out-of-network care at in-network costs. I walk them through the steps, make calls, and follow up to ensure they get the care they need. I’m not just an agent—I’m their advocate.

Without an agent, you’re not just risking enrolling in a bad plan. You’re risking facing this confusing system alone.
If you’re my client, know this: you’ve got someone fighting for you. If you’re not, maybe it’s time we had a chat.

Certainly this short article does not cover everything related to your rights with Medicare Advantage plans so if you would like to talk about this more of have additional questions about your rights or another topic, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that my help is free.  I do not charge anyone anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance or home owners insurance agent – and I will work just as hard to help you find the best plans to compare!

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

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Sources
• CMS Network Rules: Medicare Advantage plans must have enough providers to cover your needs, per federal rules in 42 CFR § 422.116.
• Your Right to Out-of-Network Care: If your plan’s network doesn’t have the providers you need, federal law (42 CFR § 422.112(a)(1)(iii) and Medicare Managed Care Manual, Chapter 4, Section 110.1.1) says your plan must cover out-of-network care at in-network costs for medically necessary services.
• Appeals Process: If your plan denies out-of-network coverage, you can appeal through their grievance process, as outlined by CMS.