Challenges in Finding Mental Health Providers

Finding a doctor or therapist can feel frustrating, especially when checking an insurance company’s provider directory. Initially, it might look like there are plenty of options. Yet, many times, those options are misleading. Some providers aren’t accepting new patients, others may work exclusively within hospitals, and a few won’t return calls at all. On top of that, incorrect phone numbers and addresses add to the confusion.

This pervasive issue has earned the nickname “ghost network.”

Inaccurate directories can be a significant hurdle for patients trying to access in-network providers. This situation can lead to high co-pays, delays in care, or patients opting out of treatment altogether, which is especially concerning in the realm of mental health.

Unfortunately, efforts to hold insurance companies accountable for these ghost networks have mostly fallen flat. State regulators can impose fines for errors in directories, but this happens rarely. Moreover, since 1974, federal law has prevented individuals with employer-sponsored health insurance from suing their insurance companies using state consumer protection laws for these issues.

However, a recent class action lawsuit may have introduced a workaround. Health plans offered by government employers aren’t affected by the federal law known as the Employee Retirement Income Security Act of 1974. A group of public servants in New York state filed a lawsuit against Emblem Health in December, alleging that it violated state regulations by failing to provide accurate information about its health plans.

The plaintiffs include six employees from New York City who claim that the ghost network from Emblem Health makes it significantly harder to access mental health care. Until recently, this company provided the most popular health insurance plan for city workers, but as of January, they’ve transitioned to a new plan in collaboration with United Healthcare.

Sarah Habiba Mark, an attorney representing the plaintiffs, pointed out that Emblem Health’s directory suggests there are more in-network mental health providers than there truly are. This tactic appears to attract members without actually compensating providers with market rates to participate.

“The more providers you list, the more members you attract, which can lead to higher premiums and better benefits,” she noted.

Furthermore, the lawsuit alleges that Emblem Health uses its ghost network to appear compliant with federal and state requirements for offering sufficient in-network options.

Another plaintiff, the American Psychiatric Association, claims that Emblem Health misrepresents the insurance coverage that psychiatrists offer, labeling it as false advertising.

“We can’t comment on ongoing litigation,” an Emblem Health spokesperson stated in an email.

Val Calderon, a New York City special education teacher and one of the plaintiffs, recounted her experience searching for a mental health provider following a miscarriage in early 2024 when she was feeling suicidal.

She vividly described her state of mind, saying, “It’s like, ‘I’m in this dark tunnel and I don’t know if I’ll ever get out of it, and I’m scared.'” Though she recognized her need for professional help for “my safety, my well-being, my life,” she spent hours online and made numerous phone calls and emails without success. Most of the providers she contacted either were out of network or not accepting new patients.

“I was furious. I’m still furious,” she expressed. “This medical insurance is supposed to provide me with mental health support, but there’s no mental health support. So I don’t have medical insurance. That’s how I see it.”

AHIP, an industry group representing health insurers, stated that plans strive to keep their directories updated, emphasizing that providers should inform companies of any changes in their contact information. Yet, providers often argue it’s the insurance companies’ responsibility to ensure directories are correct and removing someone’s name from a ghost network can be quite challenging.

“Our members frequently mention that this is a frustrating aspect of their practice,” Dr. Marketa Wills, CEO of the American Psychiatric Association, remarked.

She reflected on instances in clinical settings where patients reached out, desperately trying to assist their loved ones. “By the time they get to the fifth, sixth, or seventh provider and realize that this network is actually a ghost network, they’ve reached their limit,” she noted.

This lawsuit is one of at least seven filed in the past two years regarding insurers’ inaccurate provider lists.

Steve Cohen, a lawyer with Pollock Cohen in New York, has initiated five class-action lawsuits contesting ghost networks, all currently in the court system.

“The only way we’ll see change — and we’re hopeful for change — is through litigation,” Cohen mentioned, although he is not involved in this latest lawsuit.

Mark plans to pursue this litigation as swiftly as possible.

“I consider this an urgent health crisis. Years are too long to wait,” she stated.

While provider network accuracy can differ among insurance companies, many patients still face misleading listings. A review of five major health insurers in 2023 found that 81% of the entries had discrepancies, including incorrect addresses and specialties. In the same year, the New York State Attorney General’s Office contacted about 400 mental health professionals listed as in-network by one health plan, with 86% deemed ghost entries; for Emblem Health, the figure was 82%.

Recently, the New York State Attorney General’s Office revealed that Emblem Health would pay $2.5 million in fines and fees to the state. The company also agreed to compensate members who had to pay out of pocket for mental health care and to improve the accuracy of its provider listings. In a statement, Emblem Health said it wished to avoid protracted litigation.

An Emblem Health representative informed that the company has initiated a concierge line to assist members in scheduling appointments, expanded its provider network, and started directly offering behavioral care services.

“Emblem Health is committed to ensuring our members have the support they need to access behavioral health care in a timely and equitable manner,” they concluded.

Calderon eventually decided to put her search for an in-network provider on hold and managed as best as she could after her miscarriage. After becoming pregnant again, she gave birth to a daughter last year. However, she began experiencing postpartum depression. When her daughter was six months old, she had seizures due to fever.

“That was the point in my postpartum journey that really pushed me over the edge,” she reflected.

Ultimately, Calderon opted to pay out of pocket for sessions with a clinical social worker, which cost her $160 each week, quickly draining her savings.

“After a long day at work, just like you feel exhausted, it’s hard to catch the train to therapy because you know you’ll feel so much better by the end,” she shared.