In late 2024, New York City Fire Department emergency medical technician Nimrod Simrony attempted to take his own life. After completing an intensive outpatient treatment program, he and his wife spent months searching for a therapist.
Valeria Calderon, a special education teacher in New York City public schools, suffered a miscarriage that same year. She sought help to relieve the depression and anxiety she was suffering from before attempting to have children again. She called in more than a dozen therapists.
The therapists Simrony and Calderon contacted were listed on their insurance plan’s provider directory. That means they are likely in-network and the fees associated with the visit will be lower. Given the number of names listed, there should be plenty to choose from. But Simrony and Calderon couldn’t find an in-network provider to see them.
“I’m shocked that I couldn’t find a therapist,” Shimrony said through the directory. “That wasn’t possible.”
“It was a perfect fit,” Calderon said, but he ended up paying more to an out-of-network provider. “There is only so much you can confide in with your family, and there is only so much support they can give you.”
Mr. Simrony and Mr. Calderon are among the lead plaintiffs in a lawsuit filed last week against Emblem Health, the most popular health insurance provider for New York City employees.
City officials allege that Emblem Health’s directory contained widespread errors that gave a “deceptive” and “misleading” impression about the size of the insurer’s provider network. The employees were forced to delay or stop treatment or seek help from expensive out-of-network providers, according to the lawsuit, which seeks class action status.
Valeria Calderon, a special education teacher in the New York City school system, was having trouble finding an in-network mental health provider. Sarah Bretner of ProPublica
Health insurance companies rarely face the consequences of provider directory errors that make it difficult for many consumers to find in-network mental health care. ProPublica’s 2024 series “Mental Barriers in America” explored the harm patients face from so-called ghost networks. The series cited in the lawsuit also details the various ways insurance companies have encouraged mental health providers to stop accepting their insurance.
Many insurance companies that oversee ghost networks face only small and sporadic fines from regulators, and patients often have limited legal recourse because federal law generally limits the amount of damages they can recover.
However, there are some types of health insurance that are not subject to federal laws that limit liability, such as those offered by local governments to their employees and purchased by some individuals through the Affordable Care Act Marketplace. Damages awarded against these plans in litigation could be much higher. That is the basis of this lawsuit.
“We hope this lawsuit leverages the state’s consumer protection laws to better advocate for plan participants,” said attorney Sarah Habiba Mark, who is representing city officials.
ProPublica sent Emblem Health a list of questions about the lawsuit. Simrony and Calderon also signed a document waiving their right to privacy so the insurance company could answer questions. “We do not comment on pending litigation,” an Emblem Health spokesperson said in an email.
Lawyers have filed similar lawsuits in at least two other states against insurance companies including Kaiser Permanente and Molina. The mother of an Arizona man who died last spring after failing to find mental health treatment has sued the scheme overseen by Centene, accusing it of violating the law by publishing false information that misleads customers. (ProPublica documented the man’s struggles to find mental health care.) Those lawsuits are still ongoing, and the insurance companies in those lawsuits are contesting the claims.
This fall, the health insurance company overseen by Centene agreed to a $40 million settlement over a similar lawsuit filed by San Diego city attorneys. A spokesperson for Centene did not respond to ProPublica’s request for comment.
The New York state lawsuit was also filed on behalf of the American Psychiatric Association, which alleges that some of its 39,000 members were listed on Emblem Health’s directory without their consent. It also claimed that these lists were “artificially inflated.”[d] Its provider network is funded by psychiatrist fees. ” The complaint alleges that the directory contained numerous duplicate listings, with one psychiatrist listed 29 times.
According to the lawsuit, the errors in the directory increased the likelihood of damage to the psychiatrist’s reputation. That’s because customers who request appointments may not actually receive care and may post negative reviews.
“What we do is based on trust,” said Dr. Robert Trestman, the association’s leading ghost network expert. “So when our name is on a list saying we’re available for treatment, and then they call us and say, ‘Sorry, we’re not accepting new patients,’ that really has a negative impact.”
Calderon in his apartment in Queens. After suffering a miscarriage in early 2024, “I was on a string,” she said. Sarah Bretner of ProPublica
AHIP, the insurance industry’s top trade group, told lawmakers to take steps to ensure its members keep their rosters accurate. If you can better update your list after a provider moves or discontinues it, you may be able to correct errors in your AHIP claims faster. Mental health experts dispute that, saying insurers don’t necessarily remove listings even after a provider is formally removed from their network.
EmblemHealth serves more than 3 million people in New York and neighboring states. New York City employees are offered numerous health insurance options as part of their employment. But in recent years, about three out of five city employees have opted for the Emblem Health Plan, where premiums are covered entirely by the city. This plan was replaced in early 2026 by another plan from EmblemHealth and UnitedHealthcare.
Under the old plan, employees expected to pay less than $15 to see an in-network mental health provider, according to the complaint. All they had to do was find one in the company directory.
But some employees using the directory were unable to find an in-network provider who would take their insurance, according to the complaint. Some providers in the directory have long waiting lists, and many have incorrect contact information, which insurance companies are supposed to review. Some people no longer accept EmblemHealth, and some have never accepted it.
The plaintiffs’ claims are based on a series of practices by Emblem Health, which is under state oversight, and a company formed through a merger over many years.
In 2010, the New York State Attorney General’s Office found that Group Health, one of the insurance companies that merged with Emblem Health, “failed to maintain accurate directories.” As part of the settlement, Group Health Inc. was to annually verify that providers on the list were still in the network and correct any inaccurate listings.
In 2014, the attorney general’s office reached another settlement with Emblem Health after the insurer was found to have “unreasonably denied” coverage for treatment for mental health and substance use disorders. EmblemHealth has agreed to make some operational changes to reduce barriers to accessing these treatments. At the time of the settlement, an Emblem Health spokesperson said in a statement that the insurer was working to “improve the management of behavioral services.”
And in 2023, the Attorney General’s Office released a report finding that Emblem Health and more than a dozen other insurance companies failed to keep their lists of mental health providers free of material errors. The office’s staff contacted a sample of doctors — about 400 providers on the rosters of 13 insurance companies — and found that the majority were “unreachable, out of network, or not accepting new patients,” according to the report. According to the report, EmblemHealth’s directory found that 82% of providers who received calls were unable to accommodate appointments.
The report called on health plans to conduct regular checks on their rosters to ensure they are accurate. It also recommended that state insurance regulators “strongly enforce the law” and impose fines on insurance companies for violations.
When ProPublica previously contacted New York insurance regulators, a spokesperson could not point to any fines related to the ghost network. Last year, New York Gov. Cathy Hochul announced new regulations to “eliminate so-called ‘ghost networks,'” and while the state’s insurance regulator has posted enforcement actions on its website, it has not since posted notices of penalties against Emblem Health or other health insurers for inaccurate provider directories.
ProPublica asked state insurance regulators whether any fines have been levied against health insurance companies for inaccurate provider lists since the 2024 report. Regulators did not respond to our questions.
