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.