In late 2024, Nimrod Shimrony, an emergency medical technician for the New York City Fire Department, tried to end his life. After completing an intensive outpatient treatment program, he and his wife searched for a therapist for months.
Valeria Calderón, a special education teacher with New York City’s public school system, suffered a miscarriage that same year. Before she tried to have a baby again, she sought help with the depression and anxiety she had been struggling with. She called more than a dozen therapists.
The therapists Shimrony and Calderón contacted were listed in their insurance plan’s provider directory, meaning they were supposedly in-network and the fees associated with visiting them would be lower. Given the number of names listed, there should have been lots of options. But Shimrony and Calderón couldn’t find any in-network provider who would see them.
“It blows my mind that I couldn’t find a therapist” through the directory, Shimrony said. “It was impossible.”
“I was hanging on by a thread,” said Calderón, who eventually paid more for an out-of-network provider. “There’s only so much you can vent to your family about and only so much support that they can do.”
Shimrony and Calderón are among the lead plaintiffs in a lawsuit filed last week against EmblemHealth, which offers the most popular health plan for New York City employees.
The city employees allege that extensive errors in EmblemHealth’s directory left them with a “deceptive” and “misleading” impression about the size of the insurer’s provider network. The employees were forced to delay care, forgo treatment or seek help from costlier out-of-network providers, said the lawsuit, which is seeking class-action status.
Health insurers rarely face consequences for errors in their provider directories that make it difficult for many consumers to find in-network mental health care. ProPublica’s 2024 series, “America’s Mental Barrier,” examined the harms that patients face from so-called ghost networks. The series, which is cited in the lawsuit, also detailed the many ways that insurers have prompted mental health providers to quit accepting insurance.
Many insurers overseeing ghost networks have faced only small and sporadic fines from regulators, and patients often have limited legal recourse against them because of restrictions on the damages that typically can be recouped under federal law.
But there are health plans, such as ones local governments offer to employees or that some individuals buy through Affordable Care Act marketplaces, that aren’t covered by the federal law that restricts damages. Damages levied against those plans in lawsuits can be more substantial. That’s the basis for the current suit.
“We hope this case can use state consumer protection laws to better advocate for plan members,” said Sara Haviva Mark, an attorney representing the city employees.
ProPublica sent EmblemHealth a list of questions about the lawsuit. Shimrony and Calderón also signed documents waiving their rights to privacy so the insurer could answer questions. “We don’t comment on pending litigation,” a spokesperson for EmblemHealth wrote in an email.
Attorneys have filed lawsuits similar to the New York one in at least two other states against insurers such as Kaiser Permanente and Molina. Last spring, the mother of an Arizona man who died after being unable to find mental health treatment sued his plan, which was overseen by Centene, saying it broke the law by publishing false information that misled its customers. (ProPublica had chronicled the man’s struggles to find mental health care.) Those lawsuits are still ongoing and the insurers in those cases have disputed the allegations.
This past fall, health insurers overseen by Centene agreed to a $40 million settlement over a similar lawsuit that had been filed by San Diego’s city attorney. A spokesperson for Centene did not respond to ProPublica’s request for comment.
The New York lawsuit was also filed on behalf of the American Psychiatric Association, which alleged that some of its 39,000 members had been listed in EmblemHealth’s directory without their consent. It also claimed that those listings “artificially inflate[d] its provider network at psychiatrists’ expense.” The lawsuit claims that the directory contained many duplicate listings, with one psychiatrist listed 29 times.
The directory errors increased the chances that its psychiatrists’ reputations could be damaged, the lawsuit said. That’s because customers reaching out for appointments couldn’t actually get care — and could post negative reviews.
“What we do is based on trust,” said Dr. Robert Trestman, a leading ghost networks expert for the association. “So when our name appears in a listing that says you can get care, and then they call us, and we say, ‘Sorry, not taking new patients,’ it has a really negative impact.”
The insurance industry’s top trade group, AHIP, has told lawmakers that its members take steps to keep their directories accurate. AHIP claims errors could be fixed faster if providers better updated listings after they move or retire. Mental health experts have disputed that point: They say that insurers don’t always remove listings even after providers formally drop out of a network.
EmblemHealth covers more than 3 million people in New York and in neighboring states. New York city employees have been offered numerous options for health plans as part of their employment. But in recent years, roughly 3 out of every 5 city employees chose an EmblemHealth plan in which the premium was fully covered by the city. That plan was replaced by another one from EmblemHealth and UnitedHealthcare at the beginning of 2026.
The employees had expected to pay $15 or less to see an in-network mental health provider under the old plan, according to the lawsuit. All they had to do was find one in the company’s directory.
But, according to the lawsuit, some employees using the directory were unable to find an in-network provider willing to take their insurance. Some providers in the directory had long waitlists and many had incorrect contact information, which the insurer is supposed to check. Others no longer accepted EmblemHealth, and a few never had accepted it.
The plaintiffs’ claims follow a series of practices by EmblemHealth — and the companies that merged over the years to form it — that have come under scrutiny from state officials.
In 2010, the New York state attorney general’s office found that Group Health Inc., one of the insurers that merged into EmblemHealth, had “failed to maintain an accurate” directory. As part of a settlement, Group Health Inc. was supposed to confirm each year that the listed providers were still in the network and to correct inaccurate listings.
In 2014, the attorney general’s office reached a separate settlement with EmblemHealth after it found that the insurer “improperly denied” coverage of treatment for mental health and substance use disorders. EmblemHealth agreed to change some of its practices to reduce barriers to getting those treatments. At the time of the settlement, an EmblemHealth 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 published a report that found that EmblemHealth and another dozen insurers had failed to keep their listings of mental health providers free of extensive errors. The office’s staff had contacted a sample of doctors — nearly 400 providers listed in the 13 insurers’ directories — and the vast majority of them were “unreachable, not in-network, or not accepting new patients,” the report said. In EmblemHealth’s directory, the report found, 82% of the providers that were called were not available for an appointment.
The report called on health plans to conduct routine checks of its directories to ensure the listings were accurate. It also recommended that the state’s insurance regulator “vigorously enforce the law” and fine insurers over violations.
When ProPublica previously reached out to New York’s insurance regulator, a spokesperson couldn’t point to a single fine related to a ghost network. Last year, New York Gov. Kathy Hochul announced a new regulation to “eliminate so-called ‘ghost networks.’” But the state’s insurance regulator, which publishes enforcement actions on its website, hasn’t posted any notice of fines against EmblemHealth or other health insurers for inaccurate provider directories since then.
ProPublica asked the state’s insurance regulator if there had been any fines against health insurers for inaccurate provider directories since the 2024 story. The regulator did not answer our questions.
