Ghost Networks Class Actions

Pollock Cohen LLP and Walden Macht Haran & Williams LLP have filed two class action lawsuits against health insurance companies which are perpetrating fraud by publishing inaccurate directories of doctors - known as "ghost networks" - who supposedly accept the companies’ insurance but, in fact, do not.

The two class action lawsuits are against Carelon Behavioral Health (formerly known as Beacon Health Options) and Anthem Blue Cross and Blue Shield of New York. Both companies are owned by the same parent company: Elevance Health. The Carelon lawsuit is on behalf of more than 1.2 million New Yorkers who participate in the NYSHIP/Empire Plan. The case against Anthem is on behalf of almost 150,000 federal employees in New York.

Both lawsuits focus on access to mental health care for adults and children. The complaints detail the stories of plaintiffs who sought out mental health providers for treatment – and relied on the directories published by the health insurance companies – and could not find doctors. Either the doctors listed didn’t exists, didn’t accept the insurance, weren’t specialists in the areas the insurers claimed, or weren’t accepting new patients.

These misleading directories – known as “ghost networks” – not only waste people’s time but can result in people having to spend thousands of dollars on out-of-network doctors. And they can be dangerous, causing people to delay or abandon care.

The Carelon complaint is here. View the News Release here.

The Anthem complaint is here. View the News Release here.

The grossly inaccurate directories delay 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 lawsuits focus on access to mental health care for both adults and children. In the Carelon 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. In the Anthem complaint, two plaintiffs share their struggles as well. 

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 and 100 doctors listed in the Anthem directory. Only 17% of doctors (51 out of the 300 called) in Carelon and 7% of doctors (7 our of 100) 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.