Patients sue Elevance over mental health provider 'ghost network'
Federal workers say few or none of the mental health providers listed in plan directories were taking new patients.
Lawyers are suing on behalf of Anthem federal employee health plan members in New York state who have tried to use plan directories to find mental health care providers.
One of the two lead plaintiffs, Patricia Cavallaro-Kearns, says she has been trying, and failing, to find an in-network, in-person provider who can help her with her anxiety and attention deficit hyperactivity disorder since 2020.
The other lead plaintiff, “Jane Doe,” the mother of an unnamed child, says she has been looking unsuccessfully for an in-network provider who can help manage her child’s autism spectrum disorder since 2018.
When Doe tried to use the Anthem directory to find a provider, she “repeatedly found that the providers included in the directory were listed with inaccurate telephone numbers; did not practice the specialties listed for them in the directory; were not in-network; or did not accept her Anthem insurance,” according to the complaint.
Lawyers filed the complaint on behalf of Cavallaro-Kearns and Doe last week in the U.S. District Court for the Southern District of New York. The plaintiffs hope to represent a class consisting of members of Anthem federal employee plans in New York who have tried to find in-network mental health care providers since 2018.
The Anthem plans named as defendants are provided by subsidiaries of Elevance Health and are not governed by the Employee Retirement Income Security Act.
The Anthem plans have not yet responded to the complaint in court. Company representatives could not immediately be reached for comment.
The history: Patients, brokers and employers throughout the country have complained for years about problems with provider directory accuracy.
State legislators have introduced many directory accuracy bills, and New York has been pushing to strengthen enforcement of state provider directory standards.
Related: New York cracking down on insurers’ ‘ghost providers’ amid mental health crisis
Health plans in California recently fought off a provider directory accuracy bill in their state.
Employer groups have been taking a low-key approach to the topic. America’s Health Insurance Plans, an insurer group, has argued that directory problems are due in part to provider shortages, some types of providers’ reluctance to participate in health plan networks, and some providers’ failures to keep network directory entries up-to-date.