Centene Sued Over Alleged Mental Health Provider Directory Failures in Arizona

A lawsuit has been filed against a Centene subsidiary, Health Net of Arizona, by the mother of a deceased member, Ravy Coutinho, alleging failure to provide adequate mental health coverage. The suit focuses on the issue of ghost networks, where provider directories inaccurately list providers as in-network when they are not, violating legal requirements.

Coutinho, who moved to Arizona in 2023 and enrolled in a Centene-affiliated Ambetter Health plan via the ACA exchange, reportedly faced significant difficulty securing mental health services and medication due to inaccurate provider listings and a lack of updated directories.

The lawsuit claims that Centene and its subsidiaries intentionally inflated provider directories to attract customers, lacked sufficient in-network mental health and substance abuse providers, and did not comply with ACA, Parity Act, and No Surprises Act requirements for directory accuracy and update. Over about five months, Coutinho experienced worsening mental health, culminating in his death in May 2023.

The legal claims include wrongful death, negligence, negligent misrepresentation, consumer fraud, and insurance fraud under Arizona law, seeking punitive damages. This case highlights industry-wide concerns as similar allegations were raised against Anthem Blue Cross Blue Shield in New York, where patients faced care delays and costly out-of-network services due to ghost networks. These issues have broad implications for health plans' compliance, regulatory oversight, and patient access to essential mental health services, reflecting ongoing challenges in maintaining accurate provider networks and transparency in insurance coverage.