Why your insurer's therapist list is fake and how to get care

You have insurance, you need a therapist, and every name on the list is a dead end. Attorney Steve Cohen, who has filed seven class actions over what he calls ghost networks, says that is not an accident. His team called the first 100 child psychiatrists listed by New York's biggest insurer and found three. He explains why the lists stay broken, and the benefit buried in your policy that can get you seen now.

⏱️ Chapters:
0:00 Introduction
0:24 The directory your insurer publishes is a sham
0:48 Why 85 percent of the listings are not real
1:12 The experiment a doctor dared him to run
2:25 Only three of the first 100 were real
3:43 Seven class actions from Massachusetts to California
4:33 Sloppy lists or deliberate, and why he says deliberate
5:26 Why insurers profit when you cannot find care
7:38 The New York case with 1.2 million people in it
8:36 Insurers argue patients have no right to sue
10:48 Dentistry has a ghost network problem too
12:04 The out-of-network exception buried in your plan
13:04 Where to look when the directory fails you
16:33 The first thing he asks courts for is not money
17:47 Take home messages

About this episode:
Steve Cohen is a New York attorney who had never heard the term ghost network until a physician client asked him to run an experiment. The insurer listed 1,300 child psychiatrists near downtown Manhattan. Cohen's team called the first 100 names and found three that existed, took the insurance, and had an opening. Forty-five secret shopper studies later, he puts the average error rate for psychiatrist and psychologist listings at 85 percent, with the best network he found still wrong more than half the time. He argues this is a business decision rather than sloppy record keeping, because insurers that will not pay enough to keep therapists in network still have to certify that their networks are adequate. He walks through the seven class actions he has filed from Massachusetts to California, including a New York case against Carelon with 1.2 million people in the class that survived a motion to dismiss and is now in discovery. He explains the defenses insurers raise, the three hurdles a class action clears before trial, and why the people hurt worst are those whose plans carry no out-of-network benefit at all. For patients, he names two moves: demand the out-of-network exception buried in most policies, and use a directory like Psychology Today to find care first and fight for reimbursement second. What he asks courts for first is not money but an order to stop publishing lists that are not true.

🤝 This episode is brought to you by ModMed:
Welcome to your new AI-Powered Practice from ModMed. We're transforming specialty care by embedding AI Assistants across your entire workflow. Our all-in-one platform of EHR, patient engagement, practice management, and RCM helps reduce repetitive work while keeping you firmly in control. Trained on de-identified data from nearly a billion patient encounters, this isn't just smarter software. It's a new way of working for specialty medicine, more efficient and more connected to the patient experience. Start building your AI-Powered Practice at modmed.com.

➡️ VISIT SPONSOR: https://www.modmed.com/

🤝 Partner with me on the KevinMD platform:
With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Let's work together to tell your story.

➡️ PARTNER WITH KEVINMD: https://kevinmd.com/influencer
➡️ SUBSCRIBE TO THE PODCAST: https://www.kevinmd.com/podcast
➡️ RECOMMENDED BY KEVINMD: https://www.kevinmd.com/recommended

#MentalHealth #HealthInsurance #GhostNetworks