New York Attorney General Letitia James has reached a settlement with health insurer EmblemHealth, securing more than $2.5 million in penalties and fees after an investigation found the company failed to provide adequate access to mental health care for its members. The agreement follows an inquiry by the Office of the Attorney General (OAG) that uncovered inaccurate provider directories, overstated availability of in-network behavioral health providers, and violations of state and federal parity laws.
EmblemHealth covers about 1.5 million New Yorkers through various plans, including commercial options, Medicaid managed care, Child Health Plus, the Essential Plan, and city employee health plans. The OAG began its investigation in 2023 with a secret shopper survey targeting mental health and substance use disorder providers listed in Emblem’s online directory. The findings showed that over 80 percent of behavioral health providers marked as accepting new patients were effectively unavailable—either unreachable, not accepting new patients, or not part of the network.
Attorney General James stated: “As millions of New Yorkers struggle with anxiety, depression, and substance use disorders, ensuring access to quality, affordable mental health care is more essential than ever. Health insurers cannot mislead consumers with inaccurate provider directories while families are left without care. We are requiring Emblem to make meaningful changes so that New Yorkers can actually access the behavioral health treatment their insurance promises.”
The settlement requires EmblemHealth to pay $2.5 million in penalties and costs and establish a restitution process for members who paid out-of-pocket for mental health services due to lack of access to in-network providers. The company must also update its provider directories within two business days when errors are reported or if a provider is no longer accepting new patients. Additional reforms include:
– Adding a link next to each provider listing for reporting inaccuracies.
– Requiring providers to verify their information every 90 days.
– Removing providers from directories if they have not submitted claims within 90 days unless they confirm ongoing participation.
– Implementing systems to track complaints about directory accuracy and care access.
– Conducting regular secret shopper surveys on access and publishing results.
If a member receives an unexpected out-of-network bill due to incorrect directory information, Emblem must ensure the member pays only their usual copay or deductible.
The insurer is also required to guarantee timely appointments: within 24 hours for urgent care needs and within ten business days for initial outpatient appointments. If members cannot secure an appointment promptly with an in-network provider, they will be allowed to see an out-of-network provider but pay only their standard copay or deductible. Additionally, Emblem must develop plans to expand its behavioral health network across New York State and reduce administrative barriers for providers. An independent monitor will oversee compliance.
This action continues Attorney General James’ efforts related to mental health care accessibility. In recent years she has protected over $1 billion in student mental health grants, taken action against other insurers regarding ghost networks, and secured agreements expanding psychiatric services at hospital systems.
Letitia James leads the New York Attorney General office as it enforces civil rights laws and advocates for consumers throughout the state (https://ag.ny.gov/). The office operates regionally across New York (https://ag.ny.gov/) providing services such as fraud investigations and mediation (https://ag.ny.gov/), functioning as both a public law enforcement agency and legal advocate (https://ag.ny.gov/).
Assistant Attorneys General Michael Reisman and Carol Hunt handled this matter with assistance from Gina Bull under Health Care Bureau Chief Darsana Srinivasan.
