“For the six percent of participants who indicated that treatment was necessary but that it had not been obtained, a follow up question was asked to better understand what barriers Federal employees may be encountering when attempting to seek care. Difficulty finding an in-network provider: 33%. Difficulty finding providers accepting new patients: 30%.”

💡 One in three federal employees who needed but did not get mental health care cited Anthem-style directory problems as the reason they gave up

“The Surgeon General of the United States has described mental health as the defining public health crisis of our time, and warned of the devastating effects of mental health challenges on young people. This came as the suicide rate for young Americans jumped by 57 percent from 2001 to 2018, and pediatric visits for self-harm rose by 329 percent from 2007 to 2016.”

💡 Anthem blocked access to mental health care during a youth suicide crisis that the nation’s top doctor called the defining public health crisis of our time

“Do these plans stand to gain anything from having inaccurate information? In other words, is it inaccurate because you just haven’t spent enough money to make it accurate, or is it inaccurate by design? Well, I think there are advantages they have when their directories are unfortunately inaccurate. They use those directories for network adequacy standards.”

💡 Senate testimony revealed that inaccurate directories help insurers appear to meet legal requirements while avoiding the cost of actually providing care

“Calling psychiatrists within D.C. and Maryland, selected out of what was like a digital white-pages phone book, turned into one rejection after another. Call after call resulted in the following types of responses: Who? Hmm, s/he doesn’t work here. No, I don’t know where s/he works now. Who? I don’t know who that is, not sure they ever worked here. Hold please. [dial tone]. Recorded message: Dr. is no longer accepting new patients. If this is an emergency, hang up and call 911.”

💡 This is what it was like to use Anthem’s directory while experiencing a mental health crisis

“For people who are experiencing significant mental illness or substance use disorders, the process of going through an inaccurate provider directory to find an appointment with someone who can help them is at best demoralizing and at worst set up to precipitate clinical deterioration and a preventable crisis. Many are already experiencing profound feelings of worthlessness, fear, grief from loss and trauma, and/or the impact of substance use; some are in crisis and suicidal. Patients have told me that they felt rejected repeatedly or that somehow they themselves were at fault.”

💡 For people already suffering from depression or suicidal thoughts, Anthem’s ghost network did not just waste time. It made them worse.

“So what we are really saying here is that it is in the financial interests of these plans to discourage beneficiaries from accessing care. Because here’s the key that underlines this. Whatever insurers don’t spend on care as a result of tactics like outdated provider directories or overly restrictive networks or inaccurate information, whatever they don’t spend on care, they get to keep.”

💡 Senator Warren explained the simple profit equation: every barrier to care is money Anthem does not have to spend

“By publishing a seemingly robust, if secretly inaccurate, directory of participating providers, the Defendant is knowingly engaging in a deceptive advertising campaign intended to lure people like the Plaintiffs into choosing one of its plans. By publishing a seemingly robust but inaccurate directory of providers, the Defendant is deceptively trying to appear to comply with federal requirements that its offered plans have an adequate network of providers who actually accept the Defendant’s insurance.”

💡 The lawsuit alleges Anthem inflated its directory both to attract customers and to fake compliance with federal law

“According to the report, the OAG surveyed nearly 400 mental health providers listed on health plans’ networks and found that the overwhelming majority, 86 percent, were ghosts, meaning they were unreachable, not-in-network, or not accepting new patients. Inaccurate network directories are worsening the statewide mental health crisis and disproportionately impact marginalized communities, leading to adverse health outcomes, and increasing costs for patients.”

💡 An independent state investigation found 86% of mental health listings were fake, confirming what plaintiffs experienced

“The OAG’s findings for providers who treated children was even worse. The OAG called seven providers who were supposedly in-network with the Anthem plan and treated children. Only four of the seven were actually in-network; and the OAG was not able to make an appointment with any of them. The OAG reported Anthem as having an abysmal 100% ghost network for children.”

💡 For children’s mental health care, Anthem’s directory was 100% useless. Not a single available provider.

“The Plaintiffs have paid premiums for the Defendant’s insurance plan for coverage that never existed or was grossly inadequate. The Defendant has failed to provide an adequate network of mental health providers who actually accept the Defendant’s insurance or offer appropriate types of care. The Plaintiffs also suffered significant financial damage by having to pay thousands of dollars for out-of-network providers because there were no qualified in-network providers within a reasonable travel radius.”

💡 Plaintiffs paid twice: premiums for coverage that did not exist, then thousands more out of pocket because the directory was fake

“The No Surprises Act requires health plans to publish and maintain accurate provider directories; specifically, insurance companies must update and verify their plans’ provider directories at least every 90 days. Where plans are unable to verify provider data, they must establish a procedure to remove providers from their directories. Health plans must also update provider information within two days of receiving an update from a provider.”

💡 Federal law explicitly required Anthem to verify its directory every 90 days and remove unverified providers. The company allegedly ignored this for years.

“In September 2021, Ms. Cavallaro-Kearins began seeing an out-of-network provider, paying $240 a week out-of-pocket and upfront. From September 2021 to February 2022, she paid $240 a week and had to mail the requests for reimbursement. On numerous occasions, Anthem responded to her requests by saying that it never received the requests for reimbursements. Two to three times Ms. Cavallaro-Kearins had to mail in the statements, increasing her anxiety, stress, and frustration while paying out of pocket for mental health services that should have been covered by her insurance to begin with.”

💡 One plaintiff paid nearly $250 per week for care that should have cost $30, and Anthem made her jump through hoops even for partial reimbursement

“After hours, days, and months of calling listed in-network providers, Plaintiff Jane Doe was unable to find care for Baby Doe. For Baby Doe, there were no in-network providers with the training or experience necessary to provide adequate care within a reasonable distance of her home. Jane Doe was unable to financially afford out-of-network care. She had to forgo care for Baby Doe. In short, Ms. Doe could not find an in-network doctor to treat her child at the time the child needed care. Baby Doe never received mental health care because her mother could not find an appropriate in-network doctor.”

💡 An 8-year-old child with autism never received mental health treatment because Anthem’s directory was fiction and the family could not afford out-of-network care

“At all relevant times, the Defendant knew that its representations and omissions regarding its directory of mental health providers and coverage of mental health care were grossly inaccurate, deceptive, and misleading. Amongst the insurance industry itself, it is well known that provider directories are notoriously inaccurate. The sheer magnitude of providers who are not in-network or do not accept an Anthem plan, at least 85% of the mental health providers listed, in and of itself reflects knowledge of the directory inaccuracies. The staggering extent of inaccuracy can only be the product of knowing misconduct or willful blindness.”

💡 The lawsuit alleges Anthem knew its directory was fake. The scale of inaccuracy, 85% of listings, proves it was not an accident.

“Okay so it’s a way to defraud consumers. To say I have this really big list of people you could go to if you had a problem, and it turns out that really big list is actually this little tiny list. Right. Okay so that’s one way it’s to their advantage. They get paid in effect or they make more money by being inaccurate.”

💡 Senator Warren called it what it is: fraud. Anthem advertised a big network, charged premiums for it, then delivered almost nothing.