Blue Shield of California members may be covered by a proposed class action alleging Blue Shield and its behavioral health contractor Magellan published a mental health provider directory full of therapists who were out of network, unreachable or not taking patients, and a federal judge let most of the case proceed on September 23, 2026. No class has been certified and there is nothing to file yet.
Allegations Only · No Settlement Yet
This article describes a class action complaint. The statements below are unproven allegations. Blue Shield of California and Magellan have not been found liable, there is no certified class, and nothing to claim at this time. This page is informational. It is not legal advice.
What Is This About?
Roiz v. Blue Shield of California Life & Health Insurance Company, No. 3:25-cv-09978, is a proposed class action in the U.S. District Court for the Northern District of California, filed November 19, 2025. The amended complaint, filed March 24, 2026, names California Physicians’ Service, which does business as Blue Shield of California, along with Magellan Health, Inc., Magellan Healthcare, Inc. and Human Affairs International of California, which the complaint says manage Blue Shield’s mental health services.The plaintiffs, all Blue Shield members, allege that the defendants misled consumers “by publishing a grossly inaccurate directory of [mental health] doctors and therapists.” They say they chose Blue Shield coverage relying on its representations about the size of its network, then could not find in-network mental health care and either went without treatment or paid out of pocket.
On September 23, 2026, U.S. District Judge William H. Orrick granted the defendants’ motions to dismiss in part and denied them in part. Most of the claims against Blue Shield survived, including the ERISA and Mental Health Parity Act claims. Blue Shield and Magellan had moved to dismiss the case, arguing the claims were not adequately pleaded, and they dispute the allegations.
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What the Lawsuit Alleges
The amended complaint describes each plaintiff’s search for mental health care. One plaintiff alleges she called ten providers listed in Blue Shield’s directory and found that all were out of network, unavailable or did not offer the listed services. When she reported the problem, the complaint says, a representative told her the online directory was sometimes out of date and mailed her a printed copy, which she alleges was the same. She says she paid $150 a session out of pocket for her existing therapist until she could no longer afford it. In contrast, the complaint says she easily found in-network gastroenterology and other medical care through the same plan.The complaint also relies on “secret shopper” surveys that the plaintiffs’ lawyers arranged. In one, run in February and March 2026, researchers called a random sample of 50 in-network therapists listed as accepting new patients within 20 miles of Santa Ana, California. The complaint says an appointment could not be made with 41 of them, which it calls an 80.4% “ghost rate.” Other surveys described in the complaint, each tied to a plaintiff’s search, report ghost rates of 87% to nearly 95%. These figures come from the plaintiffs’ side and have not been tested in court.
The plaintiffs assert thirteen claims, including breach of contract, breach of the implied covenant of good faith and fair dealing, violation of California’s Unfair Competition Law, intentional and negligent misrepresentation, unjust enrichment, and three federal claims under the Employee Retirement Income Security Act: improper denial of benefits, breach of fiduciary duty and violation of the Mental Health Parity and Addiction Equity Act. They seek damages, restitution and court orders requiring changes to the network and directory.
The September 23, 2026 Ruling
Judge Orrick dismissed Blue Shield’s implied-covenant claims (the fourth and fifth causes of action). As to Magellan, he dismissed the breach of contract, implied-covenant, intentional misrepresentation, negligent misrepresentation and unjust enrichment claims, noting that the statements the plaintiffs identified were attributed to Blue Shield rather than to Magellan. He denied the rest of the motions.On the federal claims, the judge found that the complaint quoted specific plan terms — including a promise that if members cannot get timely in-network mental health care, the plan must arrange out-of-network care at in-network cost — and that the allegations were enough to state a claim for benefits. He let the ERISA fiduciary duty claim proceed against both Blue Shield and Magellan, writing that discovery may later show Magellan was not acting as a fiduciary. On the parity claim, he held that the alleged gap between how reliable Blue Shield’s mental health directory was and how reliable its medical directory was supported an inference that Blue Shield applied less rigorous network-adequacy processes to mental health care. He also held that ERISA did not preempt the state-law misrepresentation claims for the member on an employer plan.
The ruling decided only that the claims were adequately pleaded. It did not find that any allegation is true.
Who Is in the Proposed Class
The amended complaint proposes a class of everyone who bought or enrolled in a Blue Shield plan in California from November 19, 2021 through the date of class certification, with three subclasses: members of non-ERISA plans (including individual, government and public-employer coverage), members of employer plans governed by ERISA, and members who paid for out-of-network care either from a provider listed as in network or because no comparable in-network provider was available nearby. The court has not certified any class.What Happens Next
According to a stipulation filed October 5, 2026, the plaintiffs told the defendants they would not amend the complaint again, and the parties agreed that the defendants’ answers are due October 30, 2026. The Georgetown Health Care Litigation Tracker lists a case management conference for February 23, 2027. Discovery and a motion for class certification would typically follow. There is no settlement.Ghost network suits have been filed against other insurers as well, including a proposed class action over Centene’s Ambetter marketplace plans.
Questions
What is a ghost network?
A ghost network is a health plan provider directory that lists doctors or therapists as in network and available when, in practice, many cannot be reached, have left the network, are not taking new patients or do not offer the listed service. The Roiz lawsuit alleges Blue Shield of California’s mental health directory works this way. Blue Shield disputes the claims, and no court has found the allegations true.
Who would be included in the Blue Shield ghost network class action?
The amended complaint proposes a class of everyone who bought or enrolled in a Blue Shield plan in California from November 19, 2021 through class certification, with subclasses for non-ERISA plan members, ERISA (employer) plan members, and members who paid for out-of-network care. No class has been certified, so these definitions are only what the plaintiffs are asking for.
What did the judge decide in the Blue Shield ghost network case?
On September 23, 2026, U.S. District Judge William H. Orrick granted the motions to dismiss in part and denied them in part. He dismissed the implied-covenant claims against Blue Shield and the contract, implied-covenant, misrepresentation and unjust enrichment claims against Magellan. Claims that continue include breach of contract, California unfair competition, misrepresentation and unjust enrichment against Blue Shield, and ERISA benefits and fiduciary duty claims plus a Mental Health Parity Act claim against Blue Shield. The ruling decided only that the claims were adequately pleaded, not that they are true.
Is there a Blue Shield ghost network settlement or claim form?
No. As of October 21, 2026 the case is at the pleading stage, with the defendants’ answers due October 30, 2026 under a stipulation the parties filed. There is no settlement, no certified class and nothing to claim.
Is this the same as the Ambetter ghost network lawsuit?
No. The Roiz case is against Blue Shield of California and Magellan in federal court in San Francisco. A separate proposed class action makes ghost network allegations against Centene’s Ambetter marketplace plans. The cases involve different insurers, plans and courts.
Sources
• U.S. District Court, N.D. Cal. — Order Granting in Part and Denying in Part Defendants’ Motions to Dismiss, Dkt. 65 (September 23, 2026; copy via Georgetown Health Care Litigation Tracker)• First Amended Class Action Complaint, Dkt. 48 (March 24, 2026)
• Class Action Complaint (November 19, 2025)
• Joint Stipulation to Extend the Time for Defendants to Answer, Dkt. 66 (October 5, 2026)
• Georgetown University O’Neill Institute — Health Care Litigation Tracker: Roiz et al. v. California Physicians’ Service et al. (case page, last updated October 6, 2026)
