2 customers accuse Harvard Pilgrim of having "ghost networks"
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Two Massachusetts residents filed a class-action lawsuit alleging that Harvard Pilgrim is skirting laws requiring accurate provider directories.
Why it matters: State and federal laws ban "ghost networks," but several reports in recent years have found that they haven't gone away.
- Now two Bay Staters are pointing the finger at the insurer owned by Canton-based Point32Health.
- Now two Bay Staters are pointing the finger at the insurer owned by Canton-based Point32Health.
Driving the news: The lawsuit, filed last week in Suffolk Superior Court, accuses Harvard Pilgrim of deceptive and misleading practices that delayed care for customers and financially benefited the insurer.
- The policyholders, Jessica Bousquet of Worcester County and Brian Green of Hampden County, say the directory inaccurately listed several mental health providers as in-network and taking new patients.
Case in point: Bousquet, who works in special education, told Axios she spent at least an hour after work most days calling providers treating anxiety on the directory, including several listed as taking new patients.
- Every number led to a dead end — the doctor was out of network, no longer practiced or wasn't taking new patients — for 16 months, she said.
What they're saying: "I'd just try to juggle parenting while making phone calls, which is very difficult," Bousquet said.
- She caught a break with the last number she dialed: The provider called back, saying she had an opening.
- "I still remember thinking, 'Wow, did I just get lucky,'" Bousquet added.
A spokesperson for Point32 didn't respond to emails seeking comment Monday.
Stunning stats: Research consultants hired by Bousquet and Green's legal team replicated their searches on Harvard Pilgrim's directories.
- They reported an 81.6% "ghost" rate for Bousquet.
- Green, who started with a Tufts plan and enrolled in Harvard Pilgrim after they merged, had a 54% ghost rate.
- His son, who also sought treatment, had a 75% ghost rate, per the complaint.
What's next: Harvard Pilgrim will have a chance to respond to the complaint formally in Suffolk Superior Court.