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Malaysian Reserve
28-04-2025
- Health
- Malaysian Reserve
Pollock Cohen and Walden Macht File Class Action Lawsuit Against Carelon Behavioral Health
NEW YORK, April 28, 2025 /PRNewswire/ — Pollock Cohen LLP and Walden Macht Haran & Williams LLP have filed a new class action lawsuit on behalf of more than 1 million patients against Carelon Behavioral Health. Carelon provides the mental health benefits to state and municipal employees who choose the Empire Plan under the New York State Health Insurance Program (NYSHIP). The lawsuit alleges the health insurance company scammed vulnerable customers by publishing an inaccurate directory of doctors who supposedly accepted the Empire Plan insurance but, in fact, did not. Carelon's misleading directory – known as a 'ghost network' – has caused significant harm to thousands of patients. It is not only financial harm – because patients needing treatment must go to out-of-network providers, thereby incurring substantial expense – but medical complications and enormous emotional distress. The grossly inaccurate directory delays many patients' ability to find in-network care. Thousands of others simply cannot afford to pay for an out-of-network provider, and abandon their search for care – complicating their mental health condition significantly. The Empire Plan is one of multiple options available to New York State employees when selecting their health insurance plan. It competes against the other plans by advertising the benefits of its plan. Our lawsuit contends that Carelon is knowingly engaging in a deceptive advertising campaign intended to lure people into choosing the Empire Plan by drastically overstating the adequacy of its provider network. The lawsuit focuses on access to mental health care for both adults and children. In the complaint, three plaintiffs share their anguish and frustration dealing with Carelon's ghost network and detail their stories about calling countless doctors listed in Carelon's directory – thinking that did not actually accept the Empire Plan. After hearing these stories, attorneys for the plaintiffs conducted extensive 'secret shopper' studies to replicate each of the plaintiff's experiences and called 300 doctors listed in the Carelon directory. Only 17% of doctors (51 out of the 300 called) actually accepted the insurance and would see new patients. The remaining doctors either did not accept the insurance, were unreachable, did not accept new patients, or did not provide the type of service listed in the directory. 'Ghost networks are a serious, serious problem: they are not just a massive inconvenience, but a real danger to people who need medical care and can't get it,' said Steve Cohen of Pollock Cohen, one of the lead attorneys representing the plaintiffs. 'For tens of thousands of patients, this grossly inaccurate directory means delays in care. And if they can afford to go to out-of-network providers, those costs can add up to thousands of dollars. It is an abomination that they didn't get the coverage they were paying for; and more importantly, didn't receive the mental health care they or their loved one needed.' 'Carelon's inaccurate provider directory is hurting vulnerable people,' said Jacob Gardener, a partner at Walden Macht Haran & Williams and co-counsel for the plaintiffs. 'By falsely inflating its network of available providers, Carelon is violating its statutory, contractual, and common law duties, not to mention its moral obligations. Individuals relied on Carelon's misrepresentations and paid a heavy financial, psychological, and emotional price for doing so.' The complaint was filed in federal court in the Southern District of New York. Click here for the complaint. This is the second ghost network lawsuit the firms have filed. In 2024, the firms filed against Anthem HealthChoice Assurance of New York, also known as Anthem Blue Cross and Blue Shield. Both Anthem and Carelon are subsidiaries of the same parent company: Elevance Health of Indiana. About Pollock Cohen LLPPollock Cohen LLP is an impact-driven litigation firm that delivers unusually effective plaintiff-side legal representation. We are known for our ability to solve client problems—with strategy, creativity, and thought—both inside the courtroom and outside the four corners of a legalistic approach. We thrive on representing plaintiffs in cases that are impactful and meaningful, and where we can make a difference. For more information, visit About Walden Macht Haran & Williams LLPWalden Macht Haran & Williams LLP is a premier litigation boutique that handles high-stakes civil and criminal cases. Headquartered in New York, they are known for their work on high-profile complex commercial disputes, appeals, white-collar defense and investigations, monitorships, and corporate compliance matters. Walden Macht Haran & Williams strives to do good. For more information, visit
Reuters
28-04-2025
- Health
- Reuters
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.
