NEW YORK – New York Attorney General Letitia James last Thursday secured more than $2.5 million from health insurer EmblemHealth (Emblem) after an Office of the Attorney General (OAG) investigation revealed the company repeatedly failed to ensure New Yorkers could access mental health care services. The investigation found that Emblem maintained inaccurate provider directories, overstated the availability of in-network mental health and substance use disorder providers, and failed to comply with state and federal behavioral health parity laws, leaving many New Yorkers unable to find timely, affordable care when they needed it most. Under today’s settlement, Emblem will pay $2.5 million in penalties and fees, provide restitution to members who were forced to pay out of pocket for mental health care, and implement sweeping reforms to improve access to mental health and substance use disorder treatment.
“As millions of New Yorkers struggle with anxiety, depression, and substance use disorders, ensuring access to quality, affordable mental health care is more essential than ever,” said Attorney General James. “Health insurers cannot mislead consumers with inaccurate provider directories while families are left without care. We are requiring Emblem to make meaningful changes so that New Yorkers can actually access the behavioral health treatment their insurance promises.”
Emblem covers approximately 1.5 million New Yorkers through commercial plans, Medicaid managed care, Child Health Plus, the Essential Plan, and New York City employee health plans. The OAG launched an investigation into Emblem in 2023 and conducted a secret shopper survey of mental health and substance use disorder providers listed in the company’s online directory. The investigation found that Emblem’s directories contained many errors, including listings for providers who were unreachable, no longer practicing, not accepting new patients, or not actually in the plan’s network. As detailed in Attorney General James’ report, Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories, OAG determined that more than 80 percent of surveyed behavioral health providers Emblem listed as accepting new patients were effectively unavailable – creating “ghost networks” of providers that exist on paper but not in reality. Emblem’s own surveys showed similar results…