One of New York’s largest health insurers, EmblemHealth, is facing a significant $2.5 million fine for not correcting numerous errors in its mental health provider directory. This settlement comes directly from the New York attorney general’s office, which has been pursuing action against such inaccuracies for years.
The problem, often referred to as “ghost networks,” has serious implications. Many customers have struggled to find in-network mental health providers, leading some to delay treatment or pay higher costs to see out-of-network doctors. EmblemHealth has been accused of overstating the availability of mental health professionals and not complying with laws aimed at ensuring equal access to mental health care.
Letitia James, New York’s attorney general, emphasized that health insurers have a responsibility to provide accurate information to consumers. “Families cannot be left without care,” she stated.
Despite the settlement, EmblemHealth has chosen not to admit to the findings but rather to settle to avoid protracted legal battles. A representative said the company is committed to improving access to care for its members.
Recent investigations by ProPublica highlighted the challenges posed by these ghost networks, showing that this case is not an isolated one. In a report from 2023, it was revealed that EmblemHealth and several other insurers had failed to keep their provider listings accurate. Out of nearly 400 providers contacted, a staggering 82% were unavailable for appointments or were not even part of the network.
Since 2018, over 360 complaints have been lodged against EmblemHealth regarding these issues, but the company has previously failed to address them, despite earlier commitments to resolve similar problems.
As part of the settlement, EmblemHealth will now compensate customers who paid out of pocket for mental health care due to these directory errors. The insurer has also promised to rectify inaccuracies within two business days after being notified and to routinely verify the correctness of its listings every 90 days. An independent monitor will oversee the implementation of these changes.
Furthermore, EmblemHealth is involved in a lawsuit from New York City employees who claim their mental health provider options were misrepresented. While they focus on settling this issue, the larger problem of ghost networks remains a persistent obstacle for many seeking mental health care.
As expert opinions suggest, addressing these inaccuracies is essential for improving mental health access. Accurate provider directories not only enhance treatment accessibility but also restore trust in the healthcare system.
For further insights, you can refer to the New York Attorney General’s report that provides in-depth analysis on this issue.
