California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Anthem Misled Millions About Health Plan Networks, Lawsuit Alleges

On Tuesday, Consumer Watchdog filed a class-action lawsuit alleging that Anthem Blue Cross misled "millions" of consumers who enrolled in its health plans about which physicians and hospitals were included in their provider networks, Kaiser Health News reports.

Details of Lawsuit

Consumer Watchdog filed the lawsuit on the behalf of all Anthem members who purchased individual coverage through the state health insurance exchange or directly from the insurer between Oct. 1, 2013, and March 31.

Specifically, the lawsuit alleges that Anthem:

  • Delayed giving its customers complete information until it was too late for them to switch their coverage choice;
  • Did not inform its customers that it no longer offered out-of-network coverage in four of state's largest counties -- Los Angeles, Orange, San Diego and San Francisco; and
  • Misled or did not inform its customers about which doctors and hospitals were participating in the insurer's new plans.

As a result of those alleged failures, the lawsuit states that many members received thousands of dollars in unexpected medical bills and were unable to see their preferred physician.

Jerry Flanagan, lead staff attorney at Consumer Watchdog, said Anthem "intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share."

Anthem's Response

Anthem spokesperson Darrel Ng declined to comment directly on the lawsuit but said Anthem will pay the claims of members who received treatment from falsely listed physicians during the first three months of 2014.

However, he said the insurer would not extend that policy for members who found out after March 31 that their longtime doctors were not included in their plan's network (Appleby, Kaiser Health News, 7/9).

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