Cites “Ghost Networks” of Mental Health Clinicians

Washington, D.C. — The American Psychiatric Association (APA) filed a complaint (.pdf) in the U.S. District Court of the Southern District of New York against EmblemHealth, Inc., and EmblemHealth Plan, Inc., on behalf of both APA members and a proposed class of impacted patients and families.

The complaint alleges that EmblemHealth has harmed New Yorkers by offering a “ghost network” of behavioral health providers: a directory with inaccurate listings and unavailable clinicians. Ghost networks mislead individuals and obstruct their ability to find in-network care, forcing many to pay more for out-of-network care, or to delay or forgo mental health treatment altogether.

The complaint alleges that Emblem’s inaccurate and misleading provider directory constitutes unlawful deceptive acts and practices, false advertising, and violations of statutory and regulatory requirements. It also alleges that their provider directory violates federal trademark law by falsely advertising and misusing the names, identities and reputations of mental health clinicians.

EmblemHealth is the state’s largest health care plan, serving three million individuals. In 2023, the New York Attorney General issued a report entitled “Inaccurate and inadequate: Health plans’ mental health provider network directories,” which documented that while New Yorkers were struggling with a behavioral health crisis, many health insurance plans, among them EmblemHealth, were providing out-of-date and inaccurate clinician listings to their customers.

The complaint cites several cases of individuals who sought mental health care in New York through EmblemHealth for months or even years unsuccessfully, while attempting to utilize their provider directories for in-network care. The complaint also alleges that EmblemHealth misrepresents nurse practitioners as psychiatrists, repeats the same names/entities multiple times to enhance the number of clinicians, and includes clinicians who have not agreed to be part of their network.

“When insurance companies use ghost networks, they are not only reaping profits by misleading consumers, but they are also hurting people who are in need of mental health care,” said APA President Theresa Miskimen Rivera, M.D. “So often we hear heart-wrenching stories of people calling through insurance provided clinician lists for weeks or months and reaching dead ends, unable to secure timely access to necessary psychiatric treatment. Rest assured that the APA will continue to advocate on this front.”

In addition to impacting patient access, the complaint alleges that EmblemHealth is harming clinicians’ reputations by listing them in provider directories when they do not accept the plan’s insurance or do not practice at the locations where they are listed. In some cases, clinicians are unaware of their listing in the directories and have not consented to inclusion.

"The impact of ghost networks is widespread and harmful," said APA CEO and Medical Director Marketa M. Wills, M.D., M.B.A. "Not only does this practice hurt patients and families who are seeking care, but it also harms clinicians dedicated 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 Emblem network."

APA is joined in this lawsuit by New York State Psychiatric Association and Milen Byene, Valeria Calderon, Elizabeth Canty, Bonnie Doris Elliott, Daniel Riccobono, and Nimrod Shimrony, and is being represented by Sarah Haviv Mark of Mark Health Law PLLC, Caroline E. Reynolds and Jason Cowart of Zuckerman Spaeder LLP, D. Brian Hufford of The Hufford Law Firm, PLLC, and Raphael Janove of Janove PLLC.

American Psychiatric Association

The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 39,200 physician members specializing in the diagnosis, treatment, prevention, and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.