- Two individuals who purchased Centene Affordable Care Act plans have filed a lawsuit against the insurer alleging the plans were leaner than advertised, Bloomberg reports.
- Networks for Centene’s ACA plans, marketed as Ambetter, were so skimpy that customers were pressed to find providers who would take their insurance. In some cases, doctors listed as being in the network did not accept it either.
- Centene said Monday it has more than 1.4 million people signed up in ACA plans.
Centene has expanded its ACA footprint even as other insurers have pulled out of the exchange market. In July, the company announced it would offer Ambetter in 40 counties in Missouri, including 25 that were facing the possibility of no ACA options this year. At the time, Centene had 1.2 million members in exchange plans, up from 537,000 at the end of 2016.
The allegations against Centene come as the Donald Trump administration is moving toward narrower networks in ACA exchanges.
Last fall, President Trump signed an executive order relaxing health plan benefit requirements and then said he would end cost-sharing reduction payments for insurers. The combined moves paved the way for further market disruption by allowing for plans with scant coverage and fewer limits on out-of-pocket costs.
Narrow networks are not unknown in the ACA exchange market. Avalere recently reported that close to three-fourths of its ACA market comprises more restrictive networks — up from 68% in 2017.
Some analysts say restricting patients to a smaller pool of doctors and hospitals could help reduce healthcare costs by enabling payers to negotiate lower prices, leading to lower premiums and out-of-pockets costs for enrollees. But to work, these narrow networks must offer high-quality providers with proven outcomes.
The plaintiffs in Harvey v. Centene Corp. are seeking class-action status on behalf of all Ambetter customers. The case was filed Thursday in the U.S. District Court for the Eastern District of Washington.