APA Sues New York Insurer EmblemHealth Over Mental Health ‘Ghost Network’

The American Psychiatric Association (APA) and the New York State Psychiatric Association sued New York-based health insurer EmblemHealth Inc. and EmblemHealth Plan, Inc. over its inaccurate directory of in-network mental health professionals. The complaint characterized this practice as presenting a “ghost network.” The complaint was filed on behalf of APA members and a proposed class of affected EmblemHealth members.

The complaint alleges EmblemHealth’s inaccurate network directory harms the reputations of clinical mental health professionals by listing them as in-network when they are not or at locations where they do not practice, which imposes a burden on the clinical professionals when they are contacted for appointments. The complaint also alleges the inaccurate directory has harmed EmblemHealth members because it misleads members and “obstructs” their ability to find in-network care.

The complaint noted the following inaccuracies in addition to inaccurate contact information:

• Most of the listed clinical mental health professionals are affiliated with large private entities that members cannot contact directly.
• Almost half the listed clinical mental health professionals only provide services via telehealth.
• Many of the listed clinical mental health professionals are hospital-based and only see people who are hospitalized.

In some cases, the complaint alleged, the clinical mental health professionals were unaware they were listed in the directory and had not consented to inclusion. It also alleges the inaccurate provider directory violates federal trademark law by falsely advertising and misusing the names, identities, and reputations of mental health clinical professionals. The complaint also alleges that because the ghost network allows EmblemHealth to appear to have an adequate provider network, it avoids increasing reimbursement rates for psychiatrists.

EmblemHealth has more than 3 million members, according to the APA complaint. In 2023, the inaccuracies in its network directory were exposed in a report by the New York attorney general about the broader problem of ghost networks and inaccurate provider organization directories. The report assessed network directory accuracy for 13 plans in the state.

“The impact of ghost networks is widespread and harmful,” said APA Chief Executive Officer and Medical Director Marketa M. Wills, M.D., M.B.A. “Not only does this practice hurt patients and families who are seeking care, but it also harms clinicians dedicated to helping these individuals. They get phone calls asking for help and then have to explain that they are not, in fact, part of the Emblem network.”

A link to the full text of APA v. EmblemHealth is in the OPEN MINDS Circle Library.

OPEN MINDS last reported on this issue in the following articles

• 86% Of In-Network New York Mental Health Provider Organizations Do Not Offer Appointments on December 20, 2023.
• New York Cracks Down On ‘Ghost Networks’ With 10-Day Behavioral Health Access Standard on July 16, 2025.

For more information regarding the plaintiff, contact: American Psychiatric Association, 800 Maine Avenue Southwest, Suite 900, Washington, District of Columbia 20024; 202-559-3900; Email: apa@psych.org; Website: https://www.psychiatry.org/

For more information regarding the defendant, contact: Public Relations Office, EmblemHealth, 55 Water Street, New York, New York 10041; 877-411-3625; Email: press@emblemhealth.com; Website: https://www.emblemhealth.com/