Patients searching for doctors or therapists through their insurance company’s provider directory often discover inaccurate or misleading listings, a situation common enough to have earned the term “ghost network.” Browsing these directories may seem to show plenty of options, but many providers listed are not accepting new patients, only work in hospital settings, are out of network, have wrong contact information, or simply don’t return calls.
The problem is especially acute when it comes to mental health care providers. A 2023 review of physician directories from five large health insurers found that 81% of entries had inconsistencies, such as address errors or the wrong specialty listed. That same year, the New York attorney general’s office called nearly 400 mental health providers listed as in-network in one of the state’s health plans and determined that 86% were ghost entries. Among EmblemHealth providers, the share was 82%.
Legal Challenges
Since 1974, a federal law known as the Employee Retirement Income Security Act has prevented patients with employer-sponsored health plans from using state consumer protection laws to sue their insurance companies over ghost networks. However, a recent class action lawsuit has found a workaround. Health plans offered by government employers aren’t subject to that federal law, so a group of government employees from New York state sued EmblemHealth in December, alleging it violated state law by failing to provide accurate information about its health care plan.
The plaintiffs include six New York City government workers alleging EmblemHealth’s ghost network significantly impeded their access to mental health care. Val Calderon, a special education teacher for the New York City public school system, tried to find a mental health provider through EmblemHealth’s network after suffering a miscarriage and having suicidal thoughts. After hours searching online and at least a dozen calls and emails, she found no one who could take her. Most providers listed were out of network or not accepting new patients. Calderon eventually paid out of pocket $160 weekly for a clinical social worker, forcing her to dip into savings.
Settlement and Ongoing Issues
The New York attorney general’s office announced that EmblemHealth agreed to pay $2.5 million in penalties and fees, compensate members forced to pay out of pocket for mental health care, and take steps to improve provider listing accuracy. The company has established a concierge line to help members make appointments and expanded its network of providers.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.nbcnews.com/health/health-news/patients-hit-dead-ends-insurance-ghost-networks-now-are-suing-rcna255976