Two Massachusetts residents say their health insurer left them chasing mental-health care that might as well have been imaginary. In a class-action filed in Suffolk Superior Court, the pair accuse Harvard Pilgrim Health Care and its parent, Point32Health, of operating a misleading "ghost network" of mental-health providers that sent members down dead ends and stretched waits for care into months. The lawsuit claims the insurer's online directory shows therapists, psychiatrists and other specialists as in-network and accepting new patients when they are not, which the plaintiffs say pushed families into expensive out-of-network care or forced them to wait. They are seeking class certification, damages and injunctive relief.
The complaint, filed May 6 and posted online by the plaintiffs' lawyers, names Worcester County resident Jessica Bousquet and Hampden County resident Brian Green. It also lays out testing the plaintiffs say backs up their claims. As alleged in the class-action complaint, Harvard Pilgrim's directories were filled with unreachable phone numbers, duplicate entries and clinicians who no longer accepted the insurer.
Bousquet told Axios that she spent at least an hour after work most days calling through the insurer's listings, and that the search dragged on for more than a year before she finally landed an in-network therapist. "I'd just try to juggle parenting while making phone calls, which is very difficult," she said, according to Axios.
Secret-shopper testing found high 'ghost' rates
The lawsuit includes secret-shopper style studies that attempted to replicate the plaintiffs' searches and tracked whether listed clinicians were reachable, actually in-network and taking new patients.
Researchers reported an 81.6% "ghost" rate for a ChoiceNet Tiered HMO sample connected to Bousquet's search, a 54% ghost rate for Green's search for adult providers and a 75% rate for searches seeking care for minors, according to the complaint. In other words, more often than not, the supposed lifeline to care turned out to be a wrong number, a closed door or a listing that no longer took Harvard Pilgrim.
State and federal rules aim to stop ghost networks
The suit leans heavily on Massachusetts rules that govern how health plans maintain their provider directories, including technical requirements laid out in 211 CMR 52.15, and on federal standards under the No Surprises Act.
Federal guidance and materials from the Centers for Medicare & Medicaid Services say health plans must verify and update directory entries at least every 90 days and process provider updates within two business days, protections the plaintiffs say Harvard Pilgrim did not meet. The requirements are spelled out in CMS guidance.
Part of a national wave
The Harvard Pilgrim case does not exist in a vacuum. It is the latest in a series of lawsuits and regulatory crackdowns across the country focused on inaccurate health plan directories, especially in mental health.
Coverage from outlets such as Law360, along with investigative work by ProPublica, has highlighted similar cases, settlements and audits that plaintiffs' lawyers say show ghost networks are a widespread problem rather than a local glitch.
What comes next
Harvard Pilgrim and Point32Health will get their chance to respond to the allegations in Suffolk Superior Court. The filing seeks class-wide monetary relief, court-ordered changes to how the insurer maintains its directories and other injunctive measures.
A Point32Health spokesperson did not respond to emails requesting comment, Axios reported. The legal fight is likely to focus on whether judges or regulators view the directory problems as deceptive business practices or as mere administrative sloppiness with unfortunate consequences.
For members stuck on hold or cycling through dead-end listings while they wait for therapy, the lawsuit is a reminder that directory accuracy rules are not just bureaucratic fine print. As the case moves forward, expect the usual run of motions and discovery and, potentially, follow-up from regulators who have been keeping a closer eye on ghost networks nationwide.
