- In a class action lawsuit, WellPoint, Inc.'s Anthem Blue Cross of California was accused of misleading "millions of enrollees" about whether their doctors and hospitals participate in its new reform plans, and of not disclosing that many policies won't cover care outside its approved network.
- As a result, many consumers owe thousands of dollars in medical bills and can't see their longtime doctors, states the lawsuit filed July 8 in Superior Court in Los Angeles by Consumer Watchdog of Santa Monica, Calif. Anthem is the state's largest health insurer for individuals.
- The lawsuit against the insurance giant was brought on behalf of Anthem enrollees who purchased individual coverage between Oct. 1, 2013 and March 31, 2014.
This latest lawsuit against Anthem Blue Cross of California reflects growing consumer push-back against "narrow network" health plans, which are increasingly common under the Affordable Care Act. Insurers say plans with limited provider networks help to hold down premiums; surveys indicate many relatively young, healthy consumers are willing to give up broad access to providers for lower costs.
A similar suit seeking class-action status was filed June 20 against Anthem, The Los Angeles Times reported. In response to the two lawsuits, Anthem said "materials at the time of enrollment and in members' explanation of benefits have clearly stated that the plan was an EPO [exclusive provider organization] plan which may not have out of network benefits," according to The Times.
But some fed-up consumers are retaliating with lawsuits and complaints to state regulators. Due to rising numbers of complaints, state regulators are in the midst of investigating whether Anthem and Blue Shield of California provided accurate information about the doctors and hospitals in their plans.
According to the suit, Anthem delayed providing full information to consumers until it was too late for them to change coverage for 2014. The suit also alleges that Anthem failed to disclose it had stopped offering any plans with out-of-network coverage in four of the state's biggest counties: Los Angeles, Orange, San Francisco and San Diego.
A company spokesman said Anthem has agreed to pay claims of enrollees getting treatment from inaccurately listed doctors during the first three months of 2014. But he said that policy won't be extended for enrollees discovering after March 31 that their doctors had been incorrectly listed.
The state's exchange, Covered California, which is expected to announce details about next year's health plans, networks and rates later in July, is taking a close look at EPOs as it negotiates 2015 rates and coverage with insurers. Exchange officials said EPOs will continue to play a role, but they realize the product is confusing to consumers, who need to be better educated about them.