EmblemHealth Settles for $2.5 Million Over Mental Health Care Issues
One of New York’s major health insurers, EmblemHealth, is facing a hefty fine after failing to fix ongoing problems that hindered customers from accessing mental health care.
This week, the company agreed to a $2.5 million settlement. The New York State Attorney General’s Office highlighted that the inaccuracies in Emblem’s list of in-network mental health providers had persisted for years.
The settlement marks the largest penalty resulting from a prolonged effort by the attorney general’s office to address the widespread issue of provider directory errors, commonly referred to as ghost networks. Such errors often lead customers to delay or skip treatment entirely, forcing them to seek more expensive out-of-network care.
The investigation revealed that EmblemHealth had exaggerated the availability of in-network mental health providers. The company was also found to be in violation of both state and federal regulations that mandate equal access to mental health care compared to other medical services.
“Health insurance companies cannot mislead consumers with inaccurate provider lists while leaving their families without care,” said Attorney General Letitia James.
EmblemHealth has not provided any comments to ProPublica. A spokesperson indicated that while the insurer “does not acknowledge” the attorney general’s accusations, it agreed to the settlement to avoid protracted litigation and asserted its commitment to improving access to care for its members.
ProPublica’s series “America’s Mental Barriers” delved into how ghost networks restrict patient access to mental health services. Interestingly, the investigation by the attorney general’s office is one of the few instances where an elected official has exerted pressure on a health insurance company regarding this issue.
According to the settlement terms, over 360 customers raised complaints between 2018 and 2024 about these directory errors to EmblemHealth, a subcontractor managing the insurer’s mental health benefits, or the Attorney General’s Office. Despite these complaints, the insurer did not take the necessary actions to resolve the issues, even after agreeing to do so in a settlement from 2011.
A report from the attorney general’s office published in 2023 revealed that EmblemHealth, along with more than a dozen other insurers, had not kept their mental health provider lists free of significant errors. The agency’s outreach to a sample of providers—about 400 listed across 13 insurance companies—showed that many were either unreachable, out of network, or not taking new patients. Alarmingly, 82% of the providers listed in EmblemHealth’s directory were unable to offer appointments when contacted.
This week’s settlement pointed out that an examination of EmblemHealth’s directory by the attorney general’s office revealed “similar results” to those found in the earlier report.
Covering over 3 million individuals in New York and neighboring areas, EmblemHealth has committed to compensating customers who had to pay out of pocket for mental health care due to the unavailability of in-network providers.
Additionally, EmblemHealth has pledged to enhance the accuracy of its provider listings. The company will correct inaccuracies within two business days of becoming aware of them and will review all listings for accuracy every 90 days.
Compliance with these terms will be overseen by an independent monitor. Also noteworthy is the ongoing lawsuit filed by New York City officials in December, which alleges that the directory errors create a “misleading” impression of the company’s provider network size. A spokesperson for EmblemHealth has refrained from commenting on the ongoing litigation.
