The family of a deceased Centene member in Arizona is now suing the insurer for failing to adequately provide mental health coverage.
Barbara Webber, the mother of Ravi Coutinho, alleges her son died because Centene subsidiary Health Net of Arizona did not give him appropriate access to mental healthcare through his health insurance as required under law. Coutinho had struggled to find a therapist through the company’s internal directory of providers.
Coutinho was seeking a therapist after moving to Phoenix. He signed up for a health insurance plan with Centene company Ambetter Health through HealthCare.gov for $379 a month. It was one of the most popular plan options on the exchange.
He asked customer service representatives to help match him with a therapist. Phone calls, shared with ProPublica in 2024, show the company misunderstood his request and would not email him a list of eligible providers correctly fitting his situation, even after many calls. Coutinho then manually went down the list of providers in the directory and could not find a primary care doctor to refill his antidepressant medications.
Ghost networks are when an insurance company fails to keep an updated list of eligible providers for patients, despite giving the impression providers are in-network and accepting patients. Both insurers and providers have faced criticism for their role in ghost networks’ existence. Lawmakers have discussed ghost networks during congressional hearings.
“Ravi was one of many who have suffered at the hands of insurers engaging in the fraudulent—and sometimes deadly—scheme of creating 'ghost networks' to attract unsuspecting potential customers by misrepresenting the care options available under their plans,” lawyers for the family said in the lawsuit filed in the Superior Court of Arizona in Maricopa County.
The plaintiffs cited data from the Department of Health and Human Services that about one-third of the 15 million adults with serious mental illness did not receive treatment in the past year.
“Defendants’ conduct is particularly egregious because they have known for years that a health insurance plan’s inaccurate directories and inadequate mental health and primary care provider network create a substantial risk of serious harm to those needing mental health and substance misuse services, yet defendants consciously and deliberately disregarded (and continue to disregard) their interests and rights,” the lawsuit continues.
The Affordable Care Act requires plans on the federal exchange to maintain accurate provider directories for mental health services. Other federal laws, like the Mental Health Parity and Addiction Equality Act of 2008 and the No Surprises Act, offer additional protections, as do state laws in Arizona.
In Illinois in 2022, the state fined a Centene subsidiary for failing to keep updated provider directories available to members. The state of Washington fined Centene in 2017.
The city of San Diego sued Centene a year in 2021 over similar allegations, as did Centene members in Illinois the following year in a case that is still ongoing (PDF). The lawsuit involving Coutinho cites a report from the New York attorney general's office, finding Fidelis, another Centene company, had 87% of providers that were considered ghost listings.
Centene is not the only insurer to face ghost network allegations. The company did not return a request for comment.
Elevance Health has faced two separate allegations of ghost networks in recent months, through its Carelon Behavioral Health and Anthem Blue Cross Blue Shield of New York subsidiaries.