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EmblemHealth — a nonprofit health insurer in New York City — has agreed to pay the state of New York $2.5 million in penalties, fees and costs to resolve state concerns about enrollees' access to mental health care and addiction treatment services.
The insurer is also supposed to pay restitution to enrollees who paid for out-of-network behavioral health care and improve enrollees' access to behavioral health care providers, according to a settlement document posted by the New York Office of the Attorney General.
Officials in the attorney general's office have accused the insurer of violating state and federal behavioral care access parity laws, exaggerating the availability of behavioral health care providers and failing to keep its behavioral care provider directories up to date.
Secret shoppers working for the office found in 2023 that 82% of the 44 behavioral health care providers listed in an online provider directory could not be reached or were not available for near-term appointments for new patients. Officials classified the providers who could not be reached as "ghost providers."
EmblemHealth and its behavioral health services vendor found that 92% of the 600 behavioral health providers evaluated in January 2025 were ghosts, officials said.
"Health insurers cannot mislead consumers with inaccurate provider directories while families are left without care," New York Attorney General Letitia James said in a statement about the settlement.
EmblemHealth said in a response to the announcement of the settlement that it's committed to ensuring that enrollees can get behavioral health care in a timely and equitable manner.
"We have established a special concierge line to help members who may need support getting appointments with behavioral health clinicians," the company said. "We have expanded our network of providers and transitioned to providing behavioral care management services directly, rather than using a vendor, to support a member's full health journey."
What it means: Employers and benefits advisors may get more help from state and federal regulators with coping with health plan provider directory accuracy problems.
But whether the efforts will work may depend on how well the coverage providers can reconcile the interests of plan participants who want easy access to care, providers who want what they see as an adequate level of compensation, and payers who want to keep the cost of care.
EmblemHealth: EmblemHealth is a nonprofit health plan with 3.2 million enrollees.
It provides employer plans, individual coverage, and Medicare and Medicaid plans.
The backdrop: State and federal regulators have expressed increasing impatience with health insurers and managed care companies in recent years in connection with behavioral health provider directory accuracy and other behavioral health provider access concerns.
The U.S. Department of Labor's Employee Benefits Security Administration has made enforcing federal behavioral care access parity a priority.
Earlier this month, Kaiser Permanente agreed to a $32 million settlement with DOL over issues related to behavioral health provider access.
Regence BlueShield agreed in December to pay a $550,000 fine in Washington state and do a better job of responding to regulators' questions about plan enrollees' behavioral health provider access.
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