Patients hit dead ends with insurance ‘ghost networks.’ Now, some are suing.

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 many options. But it turns out that some providers aren’t accepting new patients and others only work in hospital settings. Still others are out of network or not answering calls. And some phone numbers and addresses are just plain wrong.

The situation is so common that there is a term to describe it: a ghost network.

These inaccurate or misleading doctor directories have for years been a barrier to patients seeking in-network providers and have even led some to pay large sums out of pocket, or delay or forgo care. The problem is particularly acute when it comes to mental health providers.

But attempts to hold insurance companies responsible for ghost networks have largely failed. State regulators can fine companies for directory errors, but rarely do so. 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 them.

However, a recent class action lawsuit may have found a workaround. Health plans offered by government employers are not subject to this federal law, known as the Employee Retirement Income Security Act of 1974. So a group of New York state government employees 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 officials who say EmblemHealth’s shadow network significantly hindered 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. Since January, it has offered a new plan in partnership with UnitedHealthcare.)

Attorney Sara Haviva Mark, who represents the plaintiffs, said EmblemHealth’s directory makes it appear like there are more in-network mental health providers than the company actually has, which helps it attract members without having to pay providers market rates to participate.

“The more providers that are listed, the more people that choose a plan, the higher the premiums, the more money they make,” she said.

The suit further claims that EmblemHealth’s shadow network makes it appear to comply with federal and state requirements that insurance companies offer a large number of in-network options.

The American Psychiatric Association, another plaintiff in the suit, alleges that EmblemHealth misrepresents the coverage offered by psychiatrists, which the lawsuit says constitutes 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 in the New York City public school system. Calderon said she tried to find a mental health provider through the EmblemHealth network after suffering a miscarriage in early 2024 and having suicidal thoughts.

“It kind of feels like, ‘I’m in this dark tunnel and I don’t know if I can get 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 of searching online for providers and at least a dozen calls and emails, she found no one who could support her in her moment of crisis. For the most part, she said, the providers EmblemHealth listed 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, but there’s no mental health support, so I don’t have health care coverage. That’s the way I look at it.”

AHIP, a trade group representing health insurance companies, says plans do their best to maintain up-to-date directories and that providers are responsible for alerting companies of 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 your name removed from a ghost network.

“Our members tell us 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 this in my clinical practice in the past, where patients are reaching out, crying, desperate, trying to get their loved ones the help they need. By the time they reach the fifth, sixth, seventh provider and recognize that the network is actually a ghost network, they’re at the end of their rope,” Wills said.

The lawsuit is one of seven filed in at least the past two years related to inaccurate provider lists from insurance companies.

Steve Cohen, an attorney with the Pollock Cohen firm in New York, has filed five class-action lawsuits against the ghost rings, all of which are in court.

“The only way we’re going to see change — and I believe we’re going to see change — is through litigation,” said Cohen, who is not involved in the new case.

Mark said she intends to move her case forward as quickly as possible.

“I view this as an urgent health crisis and years is too long to wait,” she said.

The accuracy of provider networks can vary by insurance company, but it is not uncommon for patients to find listings to be inaccurate or misleading. A 2023 review of doctor directories from five major health insurers found that 81% of entries had inconsistencies, such as address errors or the wrong specialty listed for a doctor.​​ 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 phantom 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 take steps to improve the accuracy of its provider lists. In a statement to ProPublica, the company said it agreed to the settlement in order to avoid tedious litigation.

An EmblemHealth spokesperson told NBC News that the company set up a concierge line to help members make appointments, expanded its provider network and shifted to providing behavioral care services directly rather than relying on a vendor.

“EmblemHealth is committed to ensuring 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 fend for herself after her miscarriage. She became pregnant again and gave birth to her daughter last year. But afterward, Calderon began experiencing symptoms of postpartum depression. Then, at 6 months old, her daughter developed fever-induced seizures.

“That was kind of the moment in my postpartum journey that really tipped 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 forced her to dip into her savings.

“Even though I’m exhausted after a long day at work, after having a one-year-old, I can’t get on the train fast enough to go to my therapy sessions because I know in the end I feel so much better,” she said.