Fresh York Attorney General Letitia James has secured a $2.5 million settlement with health insurer EmblemHealth following an investigation into inaccurate mental health provider listings. The agreement requires EmblemHealth to implement reforms aimed at improving access to care for its approximately 1.5 million New York members.
Sweeping Reforms Mandated
The investigation revealed that EmblemHealth repeatedly failed to ensure New Yorkers could access mental health care services. Specifically, the Attorney General’s office found that EmblemHealth maintained inaccurate provider directories and overstated the availability of in-network mental health and substance use disorder providers. These inaccuracies left many New Yorkers unable to discover timely, affordable care.
Under the terms of the settlement, EmblemHealth will pay $2.5 million in penalties and fees and provide restitution to members who incurred out-of-pocket expenses for mental health care due to the inaccurate directories. The insurer has also pledged to correct inaccurate listings within two business days of notification and to verify the accuracy of all listings every 90 days.
“Ghost Networks” and Compliance
The Attorney General’s office characterized the inaccurate directories as “ghost networks,” a chronic problem that has led customers to postpone treatment, forgo care, or pay higher out-of-network costs. The investigation also found that EmblemHealth failed to comply with state and federal behavioral health parity laws, which require insurers to produce mental health care as accessible as other medical care.
EmblemHealth, which covers more than 3 million people in New York and surrounding states, did not admit to the findings but agreed to the settlement to avoid litigation. The insurer stated it has “focused on taking immediate steps to further support our members’ access to care.”
Frequently Asked Questions
What prompted this settlement?
The settlement stemmed from an investigation by the New York Attorney General’s office, which found that EmblemHealth maintained inaccurate provider directories and overstated the availability of in-network mental health and substance use disorder providers.
What will EmblemHealth do as a result of the settlement?
EmblemHealth will pay $2.5 million in penalties and fees, provide restitution to affected members, and implement reforms to improve the accuracy of its provider directories. An independent monitor will oversee the insurer’s compliance with the settlement terms.
What is a “ghost network”?
A “ghost network” refers to inaccurate provider directories that list mental health providers who are unreachable, not in-network, or not accepting new patients, creating the illusion of access to care where none exists.
As EmblemHealth works to address these issues, it remains to be seen whether these changes will effectively improve access to mental health care for New Yorkers.