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.
The lawsuit is one of at least seven filed in the last two years in connection to inaccurate provider listings from insurance companies.
Steve Cohen, a lawyer at the firm Pollock Cohen in New York, has filed five class action lawsuits challenging ghost networks, all of which are moving through the court system.
“The only way we’re going to see change — and I believe we’re going to see change — is through litigation,” said Cohen, who isn’t involved in the new case.
Mark said she intends to push her case forward as quickly as she can.
“I view this as an urgent health crisis, and years are too long to wait,” she said.
The accuracy of provider networks can vary by insurance company, but it’s not uncommon for patients to find listings that are inaccurate or misleading. 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 for a physician. 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%.
The New York attorney general’s office announced last week that EmblemHealth had agreed to pay $2.5 million in penalties and fees to the state. EmblemHealth also agreed to compensate members who were forced to pay out of pocket for mental health care, and to take steps to improve the accuracy of its provider listings. In a statement to ProPublica, the company said it agreed to the settlement to avoid time-consuming litigation.
An EmblemHealth spokesperson told NBC News that the company has established a concierge line to help members make appointments, expanded its network of providers and transitioned to providing behavioral care services directly rather than using a vendor.
“EmblemHealth is committed to ensuring that our members have the support they need to access behavioral health care in a timely and equitable manner,” the spokesperson said.
Calderon temporarily gave up trying to find an in-network mental health provider and did her best to manage on her own after her miscarriage. She became pregnant again and gave birth to her daughter last year. But afterward, Calderon started to experience symptoms of postpartum depression. Then, at 6 months old, her daughter developed fever-induced seizures.
“It was sort of the point in my postpartum journey that just really threw me over the edge,” she said.
Calderon decided to pay out of pocket to see a clinical social worker. Her weekly appointments cost $160 — an expense that has forced her to dip into savings.
“As exhausted as I am after a long day of work, after having a 1-year-old, I can’t get on the train fast enough to go to my therapy sessions, because I know that by the end of it, I feel so much better,” she said.
