Lawsuit Alleges EmblemHealth Blocked Mental Health Access Through Inaccurate Directories
New York, Friday, 9 January 2026.
The complaint accuses the insurer of inflating networks with unavailable providers—listing one psychiatrist 29 times—effectively denying New York City employees access to covered mental health treatment.
Systematic Deception in Provider Directories
The class-action lawsuit, filed on December 30, 2025, in the U.S. District Court for the Southern District of New York, alleges that EmblemHealth—the largest health care plan in New York—has engaged in deceptive trade practices by maintaining inaccurate provider directories known as “ghost networks” [2][3]. The complaint, brought by the American Psychiatric Association (APA), the New York State Psychiatric Association, and individual plan members, asserts that the insurer systematically misrepresents the size and availability of its mental health network to attract members and increase revenue [2][3]. Among the specific allegations of data inflation, the lawsuit claims EmblemHealth listed a single psychiatrist 29 times, classified nurse practitioners as psychiatrists, and included clinicians who never consented to participate in the network [2][4]. The APA argues that these inaccuracies violate federal trademark law and state statutory requirements, creating a “deceptive” and “misleading” impression of network adequacy [1][2].
The Human Toll of Administrative Barriers
For the 3 million people covered by EmblemHealth, these directory errors translate into significant barriers to care [2]. The lawsuit highlights the experiences of New York City municipal employees like Nimrod Shimrony, an emergency medical technician, and Valeria Calderón, a special education teacher, who struggled to find in-network therapists in late 2024 [1]. Calderón reported contacting more than a dozen therapists listed in the directory without success, describing her mental state as “hanging on by a thread” during the search [1]. According to the complaint, these administrative obstacles force patients to either delay treatment, forgo care entirely, or incur substantial costs by seeking out-of-network providers [1][2]. Dr. Marketa Wills, CEO and Medical Director of the APA, emphasized that this practice harms not only patients but also clinicians, who must field calls from distressed individuals they cannot treat because they are not actually part of the network [3][4].
A Pattern of Regulatory Violations
This legal action follows a documented history of network adequacy issues at EmblemHealth. A 2023 investigation by the New York Attorney General’s Office revealed that approximately 82 percent of the providers listed in EmblemHealth’s directory were effectively “ghost” listings, resulting in a success rate of just 18% for members attempting to schedule mental health appointments [3][4]. The insurer has previously faced penalties for similar violations; in 2014, EmblemHealth paid a $1.2 million fine and $31 million in reimbursements for improperly denying mental health and substance use disorder coverage [3]. Despite New York Governor Kathy Hochul announcing new regulations on July 8, 2025, specifically designed to eliminate ghost networks, state regulators have not posted any fines against EmblemHealth for directory inaccuracies since that date [1]. The current lawsuit seeks both injunctive relief to correct the directories and damages for the affected class [3].