APA has filed a lawsuit along with a class of patients and families against health insurer EmblemHealth—which serves more than 3 million people in New York City and the surrounding tristate area—over the company’s alleged use of a “ghost network” of mental health providers.Why It’s Relevant
Ghost networks are inaccurate provider directories that make it appear as though a plan offers a robust network of providers, when in reality many of the listed providers are unavailable.
“Ghost networks’ impacts are widespread and harmful,” APA CEO and Medical Director Marketa M. Wills, M.D., M.B.A., said in a statement. “Not only does this practice hurt patients and families who are seeking care, it also harms clinicians who are dedicating their career to helping these individuals. They get phone calls asking for help, and then have to explain that they are not, in fact, part of the network.”
By the Numbers
- APA filed the lawsuit in the U.S. District Court of the Southern District of New York along with the New York State Psychiatric Association (an APA district branch) and six EmblemHealth plan members.
- According to the lawsuit, these individuals tried using EmblemHealth’s directories to identify in-network mental health providers but were unable to find care. Some turned to out-of-network providers, while others are still not able to access the mental health care they need.
- A 2023 report from the New York State Attorney General’s office that is cited in the lawsuit stated that of 44 calls that the Attorney General’s staff made to clinicians listed in EmblemHealth’s directory, only 18% resulted in successful appointments. For the few providers that offered appointments, the wait time was up to eight weeks.
Additional Context
- According to the lawsuit, “EmblemHealth misrepresents that its insurance plans offer a broad and accessible network of psychiatrists and other mental health providers, when they do not.” For example, many of the psychiatrists listed work in hospitals and only see hospitalized patients.
- The suit further claims that EmblemHealth inflates its network by classifying nurse practitioners as psychiatrists, repeating the same names and entities multiple times, and including clinicians who have not agreed to be part of the network.
Takeaway Message
“When insurance companies use ghost networks, they are not only reaping profits by misleading consumers, they are also hurting people who are in need of mental health care,” APA President Theresa M. Miskimen Rivera, M.D., said. “So often we hear heart-wrenching stories of people calling through insurance-provided clinician lists for weeks or months and reaching dead ends. Rest assured that the APA will continue to advocate on this front.”
Related Information
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