EmblemHealth will pay $2.5 million after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate listings, also known as “ghost networks.”
The office launched its investigation in 2013 and conducted a secret shopper survey of mental health and substance use disorder providers listed in Emblem’s online directory. The investigation found that more than 80% of surveyed behavioral health providers listed as accepting new patients were effectively unavailable, according to a Feb. 19 news release from the attorney general’s office.
Emblem insures approximately 1.5 million New York residents through commercial plans, Medicaid managed care, Child Health Plus, the Essential Plan and New York City employee health plans.
Under the settlement, Emblem will pay $2.5 million in total costs and establish a restitution process for members who paid out of pocket for mental healthcare because they could not secure an in-network appointment.
The insurer also must:
- Correct inaccurate listings within two business days.
- Provide a link for each provider listings for members to report inaccurate listings.
- Require providers to verify directory information every 90 days.
- Remove providers who have not submitted claims within the last 90 days unless they verify participation.
- Create systems to track, monitor and resolve complaints about directory inaccuracy.
- Conduct regular secret shopper surveys and report the results.
An independent monitor will oversee compliance, the release said.
