- On Tuesday, a group of 33 Anthem Blue Cross customers filed suit in the Los Angeles County Superior Court against the insurer, accusing the company of misrepresenting the size of its network and the scope of its benefits in new ACA plans.
- The customers claim that the payer canceled their PPO plan and moved them to a more-limited EPO plan, resulting in the incursion of unexpected out-of-network medical costs. The insurer denies the allegations, saying that "materials at the time of enrollment and in members' explanation of benefits have clearly stated that the plan was an EPO plan which may not have out-of-network benefits."
- Anthem, a subsidiary of WellPoint Inc. (soon to be known as Anthem Inc.) is the largest for-profit insurer in the state of California and boasts the highest exchange enrollment numbers for individual policies this year.
Meanwhile, there's two other class action lawsuits against Anthem Blue Cross pending in the same court, one filed June 20 and one filed July 8. According to the suit filed July 8, the insurer misled "millions of enrollees" about whether their doctors and hospitals participated in its new reform plans and failed to disclose that many policies won't cover care outside its approved network.
These suits are part of an overall consumer push-back against narrow networks that may result in legislative changes. According to federal officials, the Obama administration and state insurance regulators are increasing their review of provider networks and developing stricter standards to address those concerns. The new standards would be similar to provider-network adequacy standards used by CMS to oversee Medicare Advantage plans, which look at factors such as population density, maximum travel time and distance criteria. Meanwhile, states may also increase their own oversight of network size.
Although insurers maintain that they are working to improve provider databases—Anthem told the New York Times that it has added 3,800-plus physicians to its California exchange plans' network since January, a 10% increase—this may not be sufficient to appease either consumers or providers, who are often just as confused as to whether or not they are part of a given plan's network. This probably isn't the last of this kind of lawsuit.
Want to read more? You might enjoy this story on how the ultra-narrow New Hampshire network impacted excluded hospitals.