Mental health network misled policyholders about provider options, lawsuit claims
April 28 (Reuters) - A mental health care provider network that works with the health insurance plan for New York State employees was hit with a federal lawsuit on Monday over claims it misled patients looking for in-network care with lists of providers who didn't exist, didn't accept the insurance or were otherwise unreachable.
The proposed class action, filed in the U.S. District Court for the Southern District of New York by two adult New York state employees and a mother who used their insurance plan to look for a care provider for her daughter, claims that a list provided by Carelon Behavioral Health was actually a 'ghost network' of false options.
A representative for Carelon, whose parent company is Elevance Health and is based in Boston, did not immediately respond to a request for comment Monday.
The lawsuit, which seeks compensatory and punitive damages, claims the problems with the list have delayed mental health care for the patients and often forced them to pay more to go to out-of-network providers. The proposed class would include anyone enrolled in the New York State Health Insurance Program who used Carelon to look for mental health care as far back as 2019.
Some providers had the wrong phone number listed, while others had specialties that had nothing to do with mental health care, the lawsuit claims.
The number of care providers that are available obviously changes over time, but repeated checks of the list's accuracy had about 90% of it wrong, said Steve Cohen, an attorney for the plaintiffs. Cohen said federal and New York state law requires insurers to keep their lists of in-network care providers up to date.
Another lawsuit, filed last year against Anthem HealthChoice Assurance, made similar allegations about the insurer's 'ghost network' of mental health care providers for customers of the Federal Employees Health Benefits Program.
That lawsuit is still pending, according to court records. Anthem, whose parent company is also Elevance, has argued that authority over the federal employees' health insurance program lies with the U.S. Office of Personnel Management.
The case is Doe v. Carelon Behavioral Health, U.S. District Court for the Southern District of New York, No. 1:25-cv-03489.
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