{"id":397652,"date":"2026-01-09T18:03:08","date_gmt":"2026-01-09T18:03:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/397652\/"},"modified":"2026-01-09T18:03:08","modified_gmt":"2026-01-09T18:03:08","slug":"new-york-city-employees-suing-emblemhealth-after-not-being-able-to-access-mental-health-care-propublica","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/397652\/","title":{"rendered":"New York City Employees Suing EmblemHealth After Not Being Able to Access Mental Health Care \u2014 ProPublica"},"content":{"rendered":"

In late 2024, Nimrod Shimrony, an emergency medical technician for the New York City Fire Department, tried to end his life. After completing an intensive outpatient treatment program, he and his wife searched for a therapist for months.\u00a0<\/p>\n

Valeria Calder\u00f3n, a special education teacher with New York City\u2019s public school system, suffered a miscarriage that same year. Before she tried to have a baby again, she sought help with the depression and anxiety she had been struggling with. She called more than a dozen therapists.<\/p>\n

The therapists Shimrony and Calder\u00f3n contacted were listed in their insurance plan\u2019s provider directory, meaning they were supposedly in-network and the fees associated with visiting them would be lower. Given the number of names listed, there should have been lots of options. But Shimrony and Calder\u00f3n couldn\u2019t find any in-network provider who would see them.<\/p>\n

\u201cIt blows my mind that I couldn\u2019t find a therapist\u201d through the directory, Shimrony said. \u201cIt was impossible.\u201d<\/p>\n

\u201cI was hanging on by a thread,\u201d said Calder\u00f3n, who eventually paid more for an out-of-network provider. \u201cThere\u2019s only so much you can vent to your family about and only so much support that they can do.\u201d<\/p>\n

Shimrony and Calder\u00f3n are among the lead plaintiffs in a lawsuit filed last week against EmblemHealth<\/a>, which offers the most popular health plan for New York City employees.<\/p>\n

The city employees allege that extensive errors in EmblemHealth\u2019s directory left them with a \u201cdeceptive\u201d and \u201cmisleading\u201d impression about the size of the insurer\u2019s provider network. The employees were forced to delay care, forgo treatment or seek help from costlier out-of-network providers, said the lawsuit, which is seeking class-action status.<\/p>\n

\"AValeria Calder\u00f3n, a special education teacher in New York City\u2019s school system, struggled to find an in-network mental health provider. Sarah Blesener for ProPublica<\/p>\n

Health insurers rarely face consequences for errors in their provider directories that make it difficult for many consumers to find in-network mental health care. ProPublica\u2019s 2024 series, \u201cAmerica\u2019s Mental Barrier<\/a>,\u201d examined the harms that patients face from so-called ghost networks. The series, which is cited in the lawsuit, also detailed the many ways that insurers have prompted mental health providers to quit accepting insurance<\/a>.\u00a0<\/p>\n

Many insurers overseeing ghost networks have faced only small and sporadic fines from regulators<\/a>, and patients often have limited legal recourse against them because of restrictions on the damages that typically can be recouped under federal law.<\/p>\n

But there are health plans, such as ones local governments offer to employees or that some individuals buy through Affordable Care Act marketplaces, that aren\u2019t covered by the federal law that restricts damages. Damages levied against those plans in lawsuits can be more substantial. That\u2019s the basis for the current suit.<\/p>\n

\u201cWe hope this case can use state consumer protection laws to better advocate for plan members,\u201d said Sara Haviva Mark, an attorney representing the city employees.\u00a0<\/p>\n

ProPublica sent EmblemHealth a list of questions about the lawsuit. Shimrony and Calder\u00f3n also signed documents waiving their rights to privacy so the insurer could answer questions. \u201cWe don\u2019t comment on pending litigation,\u201d a spokesperson for EmblemHealth wrote in an email.<\/p>\n

Attorneys have filed lawsuits similar to the New York one in at least two other states against insurers such as Kaiser Permanente and Molina<\/a>. Last spring, the mother of an Arizona man who died after being unable to find mental health treatment sued his plan, which was overseen by Centene, saying it broke the law by publishing false information that misled its customers<\/a>. (ProPublica had chronicled the man\u2019s struggles to find mental health care<\/a>.) Those lawsuits are still ongoing and the insurers in those cases have disputed the allegations.<\/p>\n

This past fall, health insurers overseen by Centene agreed to a $40 million settlement over a similar lawsuit<\/a> that had been filed by San Diego\u2019s city attorney. A spokesperson for Centene did not respond to ProPublica\u2019s request for comment.<\/p>\n

The New York lawsuit was also filed on behalf of the American Psychiatric Association, which alleged that some of its 39,000 members had been listed in EmblemHealth\u2019s directory without their consent. It also claimed that those listings \u201cartificially inflate[d] its provider network at psychiatrists\u2019 expense.\u201d The lawsuit claims that the directory contained many duplicate listings, with one psychiatrist listed 29 times.<\/p>\n

The directory errors increased the chances that its psychiatrists\u2019 reputations could be damaged, the lawsuit said. That\u2019s because customers reaching out for appointments couldn\u2019t actually get care \u2014 and could post negative reviews.<\/p>\n

\u201cWhat we do is based on trust,\u201d said Dr. Robert Trestman, a leading ghost networks expert for the association. \u201cSo when our name appears in a listing that says you can get care, and then they call us, and we say, \u2018Sorry, not taking new patients,\u2019 it has a really negative impact.\u201d<\/p>\n

\"ACalder\u00f3n at her apartment in Queens. After suffering a miscarriage in early 2024, \u201cI was hanging on by a thread,\u201d she said. Sarah Blesener for ProPublica<\/p>\n

The insurance industry\u2019s top trade group, AHIP, has told lawmakers<\/a> that its members take steps to keep their directories accurate. AHIP claims errors could be fixed faster if providers better updated listings after they move or retire. Mental health experts have disputed that point: They say that insurers don\u2019t always remove listings even after providers formally drop out of a network.<\/p>\n

EmblemHealth covers more than 3 million people in New York and in neighboring states. New York city employees have been offered numerous options for health plans as part of their employment. But in recent years, roughly 3 out of every 5 city employees chose an EmblemHealth plan in which the premium was fully covered by the city. That plan was replaced by another one<\/a> from EmblemHealth and UnitedHealthcare at the beginning of 2026.<\/p>\n

The employees had expected to pay $15 or less to see an in-network mental health provider under the old plan, according to the lawsuit. All they had to do was find one in the company\u2019s directory.\u00a0<\/p>\n

But, according to the lawsuit, some employees using the directory were unable to find an in-network provider willing to take their insurance. Some providers in the directory had long waitlists and many had incorrect contact information, which the insurer is supposed to check. Others no longer accepted EmblemHealth, and a few never had accepted it.\u00a0<\/p>\n

The plaintiffs\u2019 claims follow a series of practices by EmblemHealth \u2014 and the companies that merged over the years to form it \u2014 that have come under scrutiny from state officials.<\/p>\n

In 2010, the New York state attorney general\u2019s office found that Group Health Inc., one of the insurers that merged into EmblemHealth, had \u201cfailed to maintain an accurate<\/a>\u201d directory. As part of a settlement, Group Health Inc. was supposed to confirm each year that the listed providers were still in the network and to correct inaccurate listings.\u00a0<\/p>\n

In 2014, the attorney general\u2019s office reached a separate settlement with EmblemHealth after it found that the insurer \u201cimproperly denied<\/a>\u201d coverage of treatment for mental health and substance use disorders. EmblemHealth agreed to change some of its practices to reduce barriers to getting those treatments. At the time of the settlement, an EmblemHealth spokesperson said in a statement that the insurer was working to \u201cimprove the management of behavioral services.\u201d<\/p>\n

And in 2023, the attorney general\u2019s office published a report<\/a> that found that EmblemHealth and another dozen insurers had failed to keep their listings of mental health providers free of extensive errors. The office\u2019s staff had contacted a sample of doctors \u2014 nearly 400 providers listed in the 13 insurers\u2019 directories \u2014 and the vast majority of them were \u201cunreachable, not in-network, or not accepting new patients,\u201d the report said. In EmblemHealth\u2019s directory, the report found, 82% of the providers that were called were not available for an appointment.\u00a0<\/p>\n

The report called on health plans to conduct routine checks of its directories to ensure the listings were accurate. It also recommended that the state\u2019s insurance regulator \u201cvigorously enforce the law\u201d and fine insurers over violations.<\/p>\n

When ProPublica previously reached out to New York\u2019s insurance regulator<\/a>, a spokesperson couldn\u2019t point to a single fine related to a ghost network. Last year, New York Gov. Kathy Hochul announced a new regulation to \u201celiminate so-called \u2018ghost networks.<\/a>\u2019\u201d But the state\u2019s insurance regulator, which publishes enforcement actions on its website, hasn\u2019t posted any notice of fines against EmblemHealth or other health insurers for inaccurate provider directories since then.\u00a0<\/p>\n

ProPublica asked the state\u2019s insurance regulator if there had been any fines against health insurers for inaccurate provider directories since the 2024 story. The regulator did not answer our questions.<\/p>\n","protected":false},"excerpt":{"rendered":"In late 2024, Nimrod Shimrony, an emergency medical technician for the New York City Fire Department, tried to…\n","protected":false},"author":2,"featured_media":397653,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":{"0":"post-397652","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/397652","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=397652"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/397652\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/397653"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=397652"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=397652"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=397652"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}