April 28 (Reuters) - A mental health care provider network that works with the health
insurance plan for New York State employees was hit with a federal lawsuit on Monday over claims
it misled patients looking for in-network care with lists of providers who didn't exist, didn't
accept the insurance or were otherwise unreachable.
The proposed class action, filed in the U.S. District Court for the Southern District of New
York by two adult New York state employees and a mother who used their insurance plan to look
for a care provider for her daughter, claims that a list provided by Carelon Behavioral Health
was actually a "ghost network" of false options.
A representative for Carelon, whose parent company is Elevance Health ( ELV ) and is based in
Boston, did not immediately respond to a request for comment Monday.
The lawsuit, which seeks compensatory and punitive damages, claims the problems with the
list have delayed mental health care for the patients and often forced them to pay more to go to
out-of-network providers. The proposed class would include anyone enrolled in the New York State
Health Insurance Program who used Carelon to look for mental health care as far back as 2019.
Some providers had the wrong phone number listed, while others had specialties that had
nothing to do with mental health care, the lawsuit claims.
The number of care providers that are available obviously changes over time, but repeated
checks of the list's accuracy had about 90% of it wrong, said Steve Cohen, an attorney for the
plaintiffs. Cohen said federal and New York state law requires insurers to keep their lists of
in-network care providers up to date.
Another lawsuit, filed last year against Anthem HealthChoice Assurance, made similar
allegations about the insurer's "ghost network" of mental health care providers for customers of
the Federal Employees Health Benefits Program.
That lawsuit is still pending, according to court records. Anthem, whose parent company is
also Elevance, has argued that authority over the federal employees' health insurance program
lies with the U.S. Office of Personnel Management.
The case is Doe v. Carelon Behavioral Health, U.S. District Court for the Southern District
of New York, No. 1:25-cv-03489.
For Doe et al: Steve Cohen of Pollock Cohen; and Jacob Gardener of Walden Macht Haran &
Williams
For Carelon: Not yet available