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The mother of an Arizona man who died after being unable to find mental health treatment is suing his health insurer, saying it broke the law by publishing false information that misled its customers.
Ravi Coutinho, a 36-year-old entrepreneur, bought insurance from Ambetter, the most popular plan on HealthCare.gov, because it seemed to offer plenty of mental health and addiction treatment options near his home in Phoenix. But after struggling for months in early 2023 to find in-network care covered by his plan, he wasn’t able to find a therapist. In May 2023, after 21 calls with the insurer without getting the treatment he sought, he was found dead in his apartment. His death was ruled an accident, likely due to complications from excessive drinking.
Coutinho was the subject of a September 2024 investigation by ProPublica that showed how he was trapped in what’s commonly known as a “ghost network.” Many of the mental health providers that Ambetter listed as accepting its insurance were not actually able to see him. ProPublica’s investigation also revealed how customer service representatives and care managers repeatedly failed to connect Coutinho to the care he needed after he and his mother asked for help. The story was part of a yearlong series, “America’s Mental Barrier,” that investigated the ways insurers employed practices that interfered with their customers’ ability to access mental health care.
The lawsuit, filed on May 23 in Maricopa County by Coutinho’s mother, Barbara Webber, accused the insurer Centene, along with the subsidiary that oversaw her son’s plan, Health Net of Arizona, of publishing an “inaccurate and misleading” provider directory. The suit also accused the companies of breaking state and federal laws, including ones that require directories to be kept accurate.
The errors in the Ambetter directory gave Coutinho a false impression about the kinds of mental health care that were actually available, the lawsuit said. According to the lawsuit, the failure to correct those errors concealed the fact that Centene companies had provided insufficient services through the Ambetter plan.
The lawsuit draws upon the findings of ProPublica’s investigation, summarizing Coutinho’s repeated attempts to find a therapist in Ambetter’s network and to get Centene representatives to connect him with a mental health provider that he could actually see.
The lawsuit also describes how Arizona insurance regulators had previously informed Health Net of Arizona that it had failed to maintain accurate provider directories. Health Net of Arizona promised to correct the errors. Regulators did not fine the insurer and declined to answer ProPublica’s questions about whether the Centene subsidiary addressed their concerns.
Centene and Health Net of Arizona didn’t respond to multiple requests for comment on the lawsuit. ProPublica previously reached out to Centene and Health Net of Arizona more than two dozen times and sent them both a detailed list of questions. None of their media representatives responded.
One of the 25 largest companies in America, Centene and its subsidiaries have been accused in past lawsuits of purposefully misrepresenting the number of in-network providers by publishing inaccurate directories. Centene lawyers have previously denied such claims in two of the bigger cases, in Illinois and California. Both cases are ongoing.
The top trade group for the industry, AHIP, has told lawmakers that companies contact in-network providers to ensure the listings are accurate. AHIP also stated that the companies could correct inaccuracies faster if providers did a better job updating their listings. Providers have told ProPublica, however, that insurers don’t always remove their names from insurer lists when they officially request to leave their networks.
Mel C. Orchard III, a partner with The Spence Law Firm who is representing Webber, told ProPublica that he intended to bring the case before a jury to hold Centene accountable for negligence and consumer fraud. The lawsuit does not state a specified amount that Webber is seeking in damages.
“Ravi is an example of the abject failure of the insurance industry to do what it’s supposed to do — and that is to insure us in times when we need them the most,” Orchard told ProPublica. “Instead they prey upon our vulnerabilities; that is what happened in this case.”
Watch a live performance of Max Blau’s investigation of Ravi Coutinho’s death, performed by actors Oscar Isaac, Kathryn Erbe and Bill Camp, produced by Theater of War Productions and presented by WNYC.
Originally sourced via trusted media partner. https://www.propublica.org/article/centene-ghost-network-lawsuit-ambetter-ravi-coutinho
