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News, Health, Santa Monica

Santa Monica Consumer Watchdog Files Suit Against Anthem Blue Cross

Posted Jul. 10, 2014, 8:11 am

Staff Report

Anthem Blue Cross misrepresented the size of its physician and hospital networks in an effort to bolster sales during the Affordable Care Act enrollment period, according to a lawsuit announced on Wednesday.

The suit, filed Tuesday in Los Angeles Superior Court by Santa Monica-based Consumer Watchdog, contends the insurer also concealed the fact that its new PPO plans had higher deductibles for out-of-network care than advertised.

"Blue Cross used false information about its provider networks, deductibles and other key terms of its coverage to trick consumers into enrolling in the company's new health plans," according to Laura Antonini, an attorney with Consumer Watchdog. "Blue Cross also collected premium payments from many consumers for months without providing consumers with proof of coverage, preventing them from accessing medical treatments and services."

Anthem officials declined to comment on the lawsuit. Spokesman Darrel Ng told Kaiser Health News that the company will pay claims of patients who received treatment from inaccurately listed doctors during the first three months of the year.

The lawsuit also accused the insurer of delaying people's enrollment in new health plans, blocking their access to medical services despite collecting their premiums, and subjecting people to long wait times on customer-service telephone lines.

"They sold new ACA-compliant health plans as being comparable to existing Blue Cross products, but they did not tell consumers that the new plans only had access to an extremely limited network of providers," attorney Michael Bidart said.

The proposed class-action lawsuit seeks a court order requiring Blue Cross to establish sufficient provider networks and to administer health plans in compliance with the law.

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Jul. 10, 2014, 11:11:30 am

Surf Diva said...

Kudos to Consumer Watchdog for taking this on. Dealing with Blue Cross has been nothing short of a nightmare. If they weren't the only insurer offering UCLA in their network, I would have quit them long ago. Everything that C.W. is claiming is true. My little daughter and I are paying close to $700 a month for the two of us...for a plan that we couldn't use for months (two months on my part and four on my daughter's behalf.) Blue Cross dropped my toddler-aged daughter repeatedly from the plan with no explanation other than to blame Covered California - which in turn said the responsibility was on Blue Cross. The hours spent resolving this are uncountable with more than FOUR HOUR waits on hold to talk to Blue Cross - which would either drop the call or have a customer service rep who obviously was not well-trained. We ended up paying more than four months of premium starting in January for a plan that my daughter couldn't use until May. Both my daughter and I had to cancel appointments, since our providers didn't want to risk providing services without proof of insurance (that we had indeed paid for, but had not received insurance cards, nor was she showing active in the system.) Everytime we resolved the problem, we would receive a letter stating that she had been dropped from the plan - just to make a call (and a subsequent 2 - 4 hour-plus wait on hold) to find out that the letter was a mistake. In my 'former life', I worked as an account exec for a major insurer, so I am not ignorant about how the system works. If someone with my level of experience can't navigate it successfully, I shudder to think of the difficulties that an average consumer would have. Thank you Consumer Watchdog for taking this on.

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