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Another Elevance Health business, this time Carelon Behavioral Health, is accused of misleading beneficiaries seeking mental health services by pushing ghost networks, or inaccurate provider directories, to its members, a new lawsuit claims.
Three plaintiffs are suing the company on behalf of more than 1 million Carelon patients through the Empire Plan in the New York State Health Insurance Program (NYSHIP). The plaintiffs said Carelon exaggerates its provider network, persuading enrollees to choose its business over NYSHIP competitors.
"It is an abomination that they didn't get the coverage they were paying for; and more importantly, didn't receive the mental health care they or their loved one needed," said Steve Cohen, an attorney for the plaintiffs and law firm Pollock Cohen.
Like the Anthem Blue Cross Blue Shield case (see below), the plaintiffs' attorneys conducted secret shopper studies and called 300 Carelon providers. Just 17% of doctors accepted insurance and agreed to see new patients.
"By falsely inflating its network of available providers, Carelon is violating its statutory, contractual, and common law duties, not to mention its moral obligations," said Jacob Gardener, a partner at Walden Macht Haran & Williams. The lawsuit clarifies incomplete provider directories violates the No Surprises Act, Mental Health Parity and Addiction Equity Act, state consumer protection and insurance law, and contractual obligations to enrollees.
[EXTERNAL LINK] - Elevance Health faces second 'ghost network' class action lawsuit
Three plaintiffs are suing the company on behalf of more than 1 million Carelon patients through the Empire Plan in the New York State Health Insurance Program (NYSHIP). The plaintiffs said Carelon exaggerates its provider network, persuading enrollees to choose its business over NYSHIP competitors.
"It is an abomination that they didn't get the coverage they were paying for; and more importantly, didn't receive the mental health care they or their loved one needed," said Steve Cohen, an attorney for the plaintiffs and law firm Pollock Cohen.
Like the Anthem Blue Cross Blue Shield case (see below), the plaintiffs' attorneys conducted secret shopper studies and called 300 Carelon providers. Just 17% of doctors accepted insurance and agreed to see new patients.
"By falsely inflating its network of available providers, Carelon is violating its statutory, contractual, and common law duties, not to mention its moral obligations," said Jacob Gardener, a partner at Walden Macht Haran & Williams. The lawsuit clarifies incomplete provider directories violates the No Surprises Act, Mental Health Parity and Addiction Equity Act, state consumer protection and insurance law, and contractual obligations to enrollees.
[EXTERNAL LINK] - Elevance Health faces second 'ghost network' class action lawsuit
