Ghost Networks Class Actions

Pollock Cohen and co-counsel Walden Macht Haran & Williams are at the forefront of national litigation – affecting millions of people – to help them get the mental health care they need and are entitled to. This litigation challenges health insurance companies’ use of grossly inaccurate provider directories of doctors – known as “ghost networks”. Pollock Cohen and Walden Macht have, to date, filed six class action lawsuits. And the Federal District Court in SDNY has sustained virtually every count in the first bellwether case. 

What are “ Ghost Networks”?

Health insurance companies are required by law to have adequate networks of doctors – in every specialty – who accept the company’s insurance. When the insurance company publishes a directory of doctors who are supposedly in the network – but in reality do not exist or won’t accept new patients – that is a ghost network.

Pollock Cohen and Walden Macht have found that many health insurance company directories are grossly inaccurate. In most cases, more than four out of every five doctors and therapists listed do not really exist, don’t accept the insurance, or won’t accept new patients.  The lawsuits challenging them allege violations of consumer protection laws, federal and state statutes, fraud, and breaches of various contracts.

In all of the cases filed, plaintiffs allege that these practices prevent access to needed care, force patients to seek costly out-of-network treatment, and often delay or disrupt critically needed mental health services.

Case Updates and "Ghost Networks" Matters

March 31, 2025: Federal District Court in SDNY Has Sustained Virtually Every Count in the First Bellwether Case

In an important “ghost network” case, a United States District Court has allowed the core claims against Carelon Behavioral Health to proceed. Judge Edgardo Ramos of the Southern District of New York denied Carelon’s motion to dismiss the plaintiff’s case alleging deceptive business practices, deceptive advertising, violations of New York Insurance Law § 4226, claims for fraudulent and negligent misrepresentation, and unjust enrichment claims.

Although the court dismissed plaintiff’s breach of contract and breach of the covenant of good faith and fair dealing claims – because Carelon’s contract was with New York State and not with the individual members – Judge Ramos allowed the alternative argument that Carelon profited unjustly to proceed.  The decision leaves intact all the core allegations and positions the case to advance on substantive grounds.

Carelon March 31, 2026 Opinion and Order 

California: Blue Shield of California Life & Health Insurance Company

The most recent class action complaint was filed in November 2025 in the United States District Court for the Northern District of California against Blue Shield of California Life & Health Insurance Company, Magellan Health, Inc., Magellan Healthcare, Inc., and Human Affairs International of California. The suit focuses on the harm caused by the insurance company’s “ghost networks” as a result of these deceptive business practices. In the complaint, multiple plaintiffs across California detail their personal or their child’s struggle to find accessible care. 

The California Blue Shield / Magellan Health complaint is here.

New York: Healthfirst PHSP

In October 2025, a class action complaint was filed in the United States District Court for the Southern District of New York against Healthfirst PHSP, Inc. (“Healthfirst”), a not-for-profit corporation registered to do business in New York, that administers the Healthfirst Essential 200-250 Plan and the Healthfirst Gold Leaf Premier Plan. The complaint alleges that Healthfirst engages in deceptive business practices by knowingly publishing an inaccurate and misleading provider directory. These inaccurate directories are known as “ghost networks.” The Class includes all individuals who have purchased or enrolled in any of Healthfirst’s Qualified Health Plans or Essential Plans—including the Gold Leaf Premier, Essential 200-250, and Essential 1 Plans—in New York at any point from 2019 through the date of class certification.

The Healthfirst complaint is here. 

Connecticut: Anthem Blue Cross Blue Shield / Carelon / Elevance

In July 2025, a class action lawsuit was filed in Connecticut state court against Anthem Blue Cross Blue Shield, Carelon, and their parent company, Elevance, for deceptive business practices and defrauding their customers by denying mandated medical services and intentionally publishing inaccurate directories of doctors. It is a class action lawsuit covering hundreds of thousands of Connecticut residents.

The Anthem/Carelon/Elevance CT complaint is here. View the News Release here.

New York: Carelon Behavioral Health / Anthem Blue Cross and Blue Shield

In April 2025 class action lawsuits are against Carelon Behavioral Health (formerly known as Beacon Health Options) and Anthem Blue Cross and Blue Shield of New York. Both companies are owned by the same parent company: Elevance Health. The Carelon lawsuit is on behalf of more than 1.2 million New Yorkers who participate in the NYSHIP/Empire Plan. The case against Anthem is on behalf of almost 150,000 federal employees in New York.

These lawsuits focus on access to mental health care for adults and children. The complaints detail the stories of plaintiffs who sought out mental health providers for treatment – and relied on the directories published by the health insurance companies – and could not find doctors. Either the doctors listed didn’t exist, didn’t accept the insurance, weren’t specialists in the areas the insurers claimed, or weren’t accepting new patients.

The Carelon complaint is here. View the News Release here.

The Anthem complaint is here. View the News Release here.

The grossly inaccurate directories delay many patients’ ability to find in-network care. Thousands of others simply cannot afford to pay for an out-of-network provider, and abandon their search for care – complicating their mental health condition significantly.

The lawsuits focus on access to mental health care for both adults and children. In the Healthfirst complaint, the plaintiff notes how they relied on the Defendant's provider directory and representations regarding its provider network when choosing their health plan, only to be subject to deceptive and misleading representations and omissions. In the Carelon complaint, three plaintiffs share their anguish and frustration dealing with Carelon’s ghost network and detail their stories about calling countless doctors listed in Carelon’s directory – thinking that did not actually accept the Empire Plan. In the Anthem complaint, two plaintiffs share their struggles as well. 

After hearing these stories, attorneys for the plaintiffs conducted extensive “secret shopper” studies to replicate each of the plaintiff’s experiences and called 300 doctors listed in the Carelon directory and 100 doctors listed in the Anthem directory. Only 17% of doctors (51 out of the 300 called) in Carelon and 7% of doctors (7 our of 100) actually accepted the insurance and would see new patients. The remaining doctors either did not accept the insurance, were unreachable, did not accept new patients, or did not provide the type of service listed in the directory.