They Couldn’t Access Mental Health Care When They Needed It. Now They’re Suing Their Insurer.
Notice what's missing.
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.
Valeria Calderón, a special education teacher in New York City’s school system, struggled to find an in-network mental health provider. Sarah Blesener for ProPublica
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 …
Notice what's missing.
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.
Valeria Calderón, a special education teacher in New York City’s school system, struggled to find an in-network mental health provider. Sarah Blesener for ProPublica
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 …
They Couldn’t Access Mental Health Care When They Needed It. Now They’re Suing Their Insurer.
Notice what's missing.
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.
Valeria Calderón, a special education teacher in New York City’s school system, struggled to find an in-network mental health provider. Sarah Blesener for ProPublica
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 …
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