State AG improves access to care for EmblemHealth members

NEW YORK — New York Attorney General Letitia James secured more than $2.5 million Thursday from health insurer EmblemHealth after an investigation revealed the company repeatedly failed to ensure New Yorkers could access mental health care services.

The Office of the Attorney General investigation found Emblem maintained inaccurate provider directories, overstated the availability of in-network mental health and substance use disorder providers, and failed to comply with state and federal behavioral health parity laws, leaving many New Yorkers unable to find timely, affordable care when they needed it most.

Under Thursday’s settlement, Emblem will pay $2.5 million in penalties and fees, provide restitution to members who were forced to pay out of pocket for mental health care and implement sweeping reforms to improve access to mental health and substance use disorder treatment.

“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,” James said in a press release. “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.”

Emblem covers about 1.5 million New Yorkers through commercial plans, Medicaid managed care, Child Health Plus, the Essential Plan and New York City employee health plans.

The OAG launched an investigation into Emblem in 2023 and conducted a secret shopper survey of mental health and substance use disorder providers listed in the company’s online directory. The investigation found Emblem’s directories contained many errors, including listings for providers who were unreachable, no longer practicing, not accepting new patients or not actually in the plan’s network.

As detailed in James’ report, Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories, the OAG determined over 80% of surveyed behavioral health providers Emblem listed as accepting new patients were effectively unavailable, creating “ghost networks” of providers that exist on paper but not in reality. Emblem’s own surveys showed similar results.

As a result of the OAG’s investigation, Emblem will pay $2.5 million in penalties, fees and costs and establish a comprehensive restitution process to repay members who were wrongfully forced to pay out of pocket for mental health care services because they were unable to schedule an appointment with an in-network provider.

In addition, James is requiring Emblem to overhaul its policies and practices to ensure online provider directories are accurate and up to date. Emblem must:

— Correct listings within two business days of learning information is incorrect or a provider is no longer accepting new patients.

— Put a link next to each provider listing that allows members and providers to report inaccurate listings directly.

— Require providers to verify directory information every 90 days and remove providers who fail to verify or are no longer available.

— Remove providers who have not submitted claims within the last 90 days from the directory unless they verify their continued participation.

— Implement new systems to track, monitor and resolve complaints related to directory accuracy and access to care.

— Conduct regular secret shopper surveys to assess access to care and publicly report the results.

If Emblem provides inaccurate provider directory information that leads a member to receive an unexpected out-of-network bill, the company must ensure the member pays only their usual copay or deductible.

James is also requiring Emblem to take steps to ensure members can access mental health and substance use disorder treatment appointments within specified time frames, including 24 hours for urgent care and 10 business days for an initial outpatient appointment.

If a member is unable to secure a timely appointment with an in-network provider, Emblem must allow the member to see an out-of-network provider but only pay their in-network copay or deductible.

The settlement also requires Emblem to develop and carry out a comprehensive behavioral health provider recruitment and retention plan to expand its network statewide and reduce administrative burdens on providers.

An independent monitor will oversee the restitution process and Emblem’s compliance with these reforms.

This action is the latest in James’ ongoing effort to protect New Yorkers’ access to mental health care and take on mental health ghost networks. In December 2025, she won a lawsuit protecting over $1 billion in mental health grants for students and young people. In August 2025, she took action to overhaul MVP Health’s mental health ghost network. In April 2025, she secured a landmark settlement with WMCHealth to expand access to inpatient psychiatric care in the Hudson Valley and overhaul how the hospital system treats patients experiencing mental health crises.

This matter was handled by assistant attorneys general Michael Reisman and Carol Hunt, with assistance from Assistant Attorney General Gina Bull, under the supervision of Health Care Bureau Chief Darsana Srinivasan. The Health Care Bureau is part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.

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