It’s a familiar frustration for those trying to find a doctor or therapist: You browse the provider directory on your insurance company’s portal and, at first, it seems like there are plenty of options. But it turns out that some providers are not accepting new patients, and others only work in hospital settings. Still others are out of network or don’t return calls. And some phone numbers and addresses are simply wrong.
The situation is so common that there’s a term for it: a ghost network.
These inaccurate or misleading physician directories have for years been an obstacle for patients seeking in-network providers and have even led some to pay large sums out of pocket, or to delay or forgo care. The problem is especially acute when it comes to mental health care providers.
But attempts to hold insurance companies accountable for ghost networks have largely fallen short. State regulators can fine the companies for directory errors but rarely do. And since 1974, a federal law has prevented patients with employer-sponsored health plans from using state consumer protection laws to sue their insurance companies over the issue.
However, a recent class action lawsuit may have found a work-around. Health plans offered by government employers aren’t subject to that federal law, known as the Employee Retirement Income Security Act of 1974. So a group of government employees from New York state sued EmblemHealth in December, alleging that it violated state law by failing to provide accurate information about its health care plan.
The plaintiffs include six New York City government workers who allege that EmblemHealth’s ghost network has significantly impeded their access to mental health care. (Before the start of this year, EmblemHealth offered the most popular health insurance plan for New York City workers. As of January, it offers a new plan in partnership with UnitedHealthcare.)
Attorney Sara Haviva Mark, who represents the plaintiffs, said EmblemHealth’s directory makes it appear that there are more in-network mental health providers than the company actually has, helping it to attract members without having to actually pay providers market rates to participate.
“The more providers that are listed, the more people that will choose a plan, the more premiums, the more money they make,” she said.
The suit further claims that EmblemHealth’s ghost network makes it seem like it’s compliant with federal and state requirements that insurance companies offer an ample number of in-network options.
The American Psychiatric Association, another plaintiff in the suit, alleges that EmblemHealth misrepresents the coverage that psychiatrists offer, which the lawsuit says is false advertising.
In an emailed statement, an EmblemHealth spokesperson said: “We do not comment on pending litigation.”
Val Calderon, one of the plaintiffs in the suit, is a special education teacher for the New York City public school system. Calderon said she tried to find a mental health provider through EmblemHealth’s network after suffering a miscarriage in early 2024 and having suicidal thoughts.
“You sort of feel like, ‘I’m in this dark tunnel and I don’t know if I can pull myself out of it, and I’m scared,’” she said.
Calderon said she knew she needed professional help “for my safety, for my well-being, for my life.” But after hours searching online for providers and at least a dozen calls and emails, she found no one who could take her in her moment of crisis. For the most part, she said, the providers listed by EmblemHealth were out of network or not accepting new patients.
“I felt enraged. I still feel enraged,” Calderon said. “This health care coverage is supposed to provide me with mental health support, and there isn’t any mental health support — so I don’t have health care coverage. That’s how I look at it.”
AHIP, a trade group representing health insurance companies, says that plans do their best to maintain up-to-date directories, and that providers are responsible for alerting companies about changes to their contact information. Providers, meanwhile, say it’s up to insurance companies to make sure directories are accurate and that it’s often difficult to get one’s name removed from a ghost network.
“We do hear from our members all the time that this is a very difficult part of their practice that they have to manage,” said Dr. Marketa Wills, CEO of the American Psychiatric Association.
“I’ve even had it in my clinical practice in the past, where patients are reaching out, crying, desperate, trying to get their loved ones the help that they need. By the time they reach the fifth, sixth, seventh provider and recognize that the network is really a ghost network, they are at their wit’s end,” Wills said.
