Patients hit dead ends with insurance 'ghost networks.' Now, some are suing.
#ghost networks #insurance directories #mental health access #class action lawsuit #EmblemHealth #provider accuracy #out-of-pocket costs #patient rights
📌 Key Takeaways
- New York employees and APA sued EmblemHealth over 'ghost network' of mental health providers
- Ghost networks refer to inaccurate insurance directories listing unavailable or out-of-network providers
- Plaintiff Val Calderon couldn't find in-network care after miscarriage and paid out-of-pocket for therapy
- EmblemHealth agreed to $2.5 million settlement but lawsuit continues
- This case is part of growing legal movement against insurance directory inaccuracies
📖 Full Retelling
New York government employees, represented by attorney Sara Haviva Mark and including the American Psychiatric Association, filed a class action lawsuit against EmblemHealth in December 2025 over its so-called 'ghost network' of mental health providers, alleging that the insurance company's inaccurate and misleading directory significantly impedes access to care, forcing patients like Val Calderon to either pay out of pocket or forgo essential mental health treatment after finding listed providers were unavailable, out-of-network, or not accepting new patients. The phenomenon of 'ghost networks' refers to insurance provider directories that list doctors or therapists who are either not accepting new patients, only work in hospital settings, are actually out-of-network, have incorrect contact information, or simply don't return calls. This widespread issue has created significant barriers for patients seeking in-network care, particularly in the mental health field, and has led some to delay or completely forgo necessary treatment. The problem is compounded by a federal law from 1974 that prevents patients with employer-sponsored health plans from suing their insurance companies using state consumer protection laws, though government employee plans are exempt from this restriction. Val Calderon, a New York City public school teacher and one of the plaintiffs, experienced the dire consequences of these ghost networks firsthand after suffering a miscarriage in early 2024 and experiencing suicidal thoughts. Despite desperately needing professional help, she spent hours searching online and made at least a dozen calls and emails to providers listed in EmblemHealth's network, only to find none who could take her in her moment of crisis. 'I felt enraged. I still feel enraged,' Calderon said, explaining that she had to pay $160 per week out of pocket for therapy when she became pregnant again and experienced postpartum depression. The lawsuit claims that EmblemHealth intentionally maintains these ghost networks to attract more members and collect higher premiums without actually paying providers market rates to participate, while appearing compliant with federal and state requirements regarding adequate provider networks.
🏷️ Themes
Healthcare access, Insurance practices, Legal action, Mental health
📚 Related People & Topics
EmblemHealth
American health insurance company
EmblemHealth Inc doing business as EmblemHealth,, is one of the United States' largest nonprofit health plans. Headquartered at 55 Water Street in Lower Manhattan, New York City, it is a multi-billion-dollar organization with over 3 million members. EmblemHealth was created in 2006 through the merge...
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Original Source
Patients hit dead ends with insurance 'ghost networks.' Now, some are suing. A recent lawsuit is challenging one company, EmblemHealth, over its so-called ghost network of mental health providers. Add NBC News to Google Lawsuit alleges insurance company provider list is a 'Ghost Network' 03:31 Get more news on Share Add NBC News to Google Feb. 24, 2026, 7:03 PM EST By Aria Bendix , Jessica Herzberg and Kate Snow Listen to this article with a free account 00:00 00:00 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...
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