New York Attorney General Letitia James announced a $2.5 million EmblemHealth ghost network settlement on February 19, 2026, resolving an investigation that found the insurer’s mental health provider directory was almost entirely fiction. Only about 18% of the behavioral health providers investigators called were actually reachable and able to schedule an appointment. Under the deal, EmblemHealth must fix the directory, guarantee timelines for getting an appointment, cover out-of-network costs when it can’t, and reimburse members who already paid out of pocket for care they should have received in-network.
What Investigators Found
The Attorney General’s office opened its investigation in 2023 and used a “secret shopper” survey: staff called mental health providers that EmblemHealth’s online directory listed as accepting new patients. Of 44 providers contacted, only eight offered an appointment. The other 82% were unreachable, no longer in the network, or not accepting new patients.1NY AG. EmblemHealth Inc. Assurance of Discontinuance
The pattern went much deeper than a handful of outdated listings. Between 2019 and 2024, more than 6,400 behavioral health providers in EmblemHealth’s network filed zero claims, meaning they appeared in the directory but were not treating any of the insurer’s members. Among Essential Plan members in 2023, 87% of behavioral health providers were similarly inactive. EmblemHealth had also received at least 360 member complaints between 2018 and 2024 about directory inaccuracies or inability to find treatment.1NY AG. EmblemHealth Inc. Assurance of Discontinuance
Investigators also flagged a gap between mental health and medical access inside the network. EmblemHealth granted “in-network exceptions,” which let members see out-of-network providers at in-network rates, at a much higher rate for mental health than for medical or surgical care. That gap suggested in-network mental health providers were far harder to actually reach, which the AG’s office treated as a possible violation of state and federal parity laws.1NY AG. EmblemHealth Inc. Assurance of Discontinuance
The effect on members was direct. People searching the directory for mental health care called providers listed as available, found most were not, and either paid for more expensive out-of-network care, delayed treatment, or gave up. The AG’s office called the listings “deceptive” and “misleading.”2ProPublica. EmblemHealth Ghost Network Settlement
What EmblemHealth Must Change
The $2.5 million payment covers penalties, fees, and costs. The operational reforms are the larger part of the deal.3NY AG. Attorney General James Secures Sweeping Reforms Improving Access to Mental Health
Directory Accuracy
EmblemHealth must correct inaccurate listings within two business days of identifying an error. Every provider listing must include a direct link members can use to report inaccuracies. The insurer must verify provider information every 90 days, and any provider who fails to respond to verification requests or who has filed no claims in 90 days must be removed from the directory.3NY AG. Attorney General James Secures Sweeping Reforms Improving Access to Mental Health
Appointment Timelines
Members must be able to get an urgent behavioral health appointment within 24 hours and an initial outpatient appointment within 10 business days. If EmblemHealth cannot meet those timelines with an in-network provider, it must authorize the member to see an out-of-network provider and charge only the in-network copay or deductible.4Healthcare Finance News. New York Secures More Than $2.5 Million From EmblemHealth Over Ghost Networks
Network Building and Oversight
EmblemHealth must develop a recruitment and retention plan to grow its behavioral health network statewide, build systems to track and resolve directory and access complaints, and run regular secret shopper surveys with public reporting of the results. An independent monitor will oversee the insurer’s compliance with the reforms.3NY AG. Attorney General James Secures Sweeping Reforms Improving Access to Mental Health
Money Back for Affected Members
EmblemHealth must set up a process to reimburse members who ended up paying out of pocket for mental health care because they could not get an appointment with a listed in-network provider. The independent monitor will oversee that restitution process along with the broader reforms. Specific instructions on how members file a restitution claim had not been released as of the settlement announcement, so anyone who thinks they qualify should watch for EmblemHealth’s forthcoming notice and keep receipts, statements, and any records of calls to listed providers who turned out to be unavailable.3NY AG. Attorney General James Secures Sweeping Reforms Improving Access to Mental Health
The settlement also includes a forward-looking billing protection. If the directory leads a member to believe a provider is in-network and the member then receives a surprise out-of-network bill, the insurer must ensure the member pays only the in-network copay or deductible.4Healthcare Finance News. New York Secures More Than $2.5 Million From EmblemHealth Over Ghost Networks
The Separate Class Action Is Not Part of This Deal
The AG settlement is not the only case against EmblemHealth over ghost networks, and one does not resolve the other. On December 30, 2025, the American Psychiatric Association, the New York State Psychiatric Association, and several individual plaintiffs filed a class action in the U.S. District Court for the Southern District of New York. The complaint alleges deceptive practices and false advertising, and claims EmblemHealth misrepresented nurse practitioners as psychiatrists and listed clinicians who never agreed to participate in the network.5American Psychiatric Association. APA Class Action Complaint Against EmblemHealth
The case, before Judge John G. Koeltl, was still in active litigation as of mid-2026, with EmblemHealth’s motion to dismiss pending.6Georgetown Law Litigation Tracker. American Psychiatric Association et al. v. EmblemHealth, Inc. et al.
Why New York Is Leading on This
The EmblemHealth deal is part of an ongoing enforcement push by the New York AG. A December 2023 report from the office, Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories, surveyed 13 health plans and made nearly 400 calls to listed providers. Only 14% of those calls produced an offered appointment, with individual plan success rates ranging from 0% to 35%.7NY AG. Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories
That report led to a string of settlements, including an August 2025 deal with MVP Health Plan after a secret shopper survey found 100% of listed mental health providers were unavailable. MVP agreed to pay $250,000, reimburse members for excess mental health costs going back to January 2020, and verify providers every 90 days.8NY AG. Attorney General James Secures Settlement With MVP Health Plan Over Mental Health The EmblemHealth settlement is the most extensive in the series so far, and its combination of two-day directory corrections, 24-hour urgent appointment access, and independent monitoring is the template mental health advocates and regulators in other states are now watching.
For EmblemHealth members, the immediate practical answer is this: the directory should get more accurate; urgent care should be reachable within a day and initial outpatient care within 10 business days; if it isn’t, an out-of-network provider should be authorized at in-network cost; and if you paid out of pocket for mental health care because a listed provider wasn’t actually available, a reimbursement process is coming.