UPDATED: Nonprofit Sues Blue Cross Over Obamacare Networks


A Southern California nonprofit filed a class-action lawsuit Tuesday alleging that Anthem Blue Cross misled millions of customers when rolling out its plans under the Affordable Care Act, leaving many enrollees on the hook for large out-of-pocket expenses.

According to a report in the Sacramento Bee, the suit alleges that the insurance giant published inaccurate provider networks, causing many customers to purchase plans thinking their current doctors and health care providers were classified as “in-network.” The suit also alleges Anthem failed to inform customers that many of its Covered California policies wouldn’t reimburse for care provided outside of its approved network.

Anthem spokesman Darrel Ng is quoted in the Bee story saying the company has agreed to pay out-of-network claims from folks who received treatment from inaccurately listed doctors during the first three months of this year. Consumer Watchdog, the Santa Monica-based nonprofit that filed the suit, countered that the company intentionally misrepresented and concealed the limitations of its plans in order to capture a big market share in the newly created insurance exchange.

News of the suit may be of special interest here on the North Coast, where customers have had their share of frustrations over Anthem Blue Cross’ inaccurate provider lists, as detailed in past Journal coverage here. Currently, the lawsuit’s class consists of six plaintiffs from Los Altos Hills, Moraga and San Jose.

Laura Antonini, a staff attorney for Consumer Watchdog, said the lawsuit will be opened up to include all Anthem Blue Cross customers who purchased plans through the insurance exchange if it is ultimately certified by the court as a class action suit. But, Antonini said, that process could take years.

The suit was filed amid a recent flurry of concern surrounding Anthem Blue Cross and Blue Shield of California’s handling of their Covered California plans that resulted in the state’s launching an investigation into the companies’ practices last month. The California Department of Managed Health Care began its formal investigation June 20, with spokeswoman Marta Green telling the Los Angeles Times, “Our preliminary investigation gave us good cause to believe there are violations of the law.”

As a part of its investigation, the department has reportedly contracted with a consulting firm, PMPM Consulting, to call health care providers to survey the accuracy of the two insurance companies provider network directories. The California Medical Association sent out a letter to its members late last month, which was forwarded around locally by the Humboldt-Del Norte Medical Association, urging physicians to cooperate with PMPM’s survey. “This is an investigation into the accuracy of the plan directories and whether the plans have violated any laws, not an investigation of physician practices,” the letter states.

The CMA urges patients having trouble finding in-network providers under their Covered California plans to call the Department of Managed Health Care’s help center at (888) 466-2219.

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