Lawsuit Alleges That Health Insurers Improperly Denied Coverage for Emergency Care
Some health insurers violate state law by "systematically" refusing to cover emergency treatment, and some hospitals overbill policyholders for such services, according to a class-action lawsuit filed Monday in Los Angeles Superior Court, Reuters/Orange County Register reports.
The lawsuit -- filed by Cotchett, Pitre, Simon & McCarthy on behalf of health plan members -- names WellPoint Health Networks, Blue Cross of California, Blue Shield of California, CIGNA HealthCare of California, PacifiCare of California, AET Healthcare Plan of California, Aetna Health of California, Health Net of California and Kaiser Foundation Health Plan.
Under state law, health insurers must cover all emergency services. Doctors and hospitals also cannot overcharge or attempt to bill patients whose health insurer has illegally refused to cover such services, Reuters/Register reports.
According to Reuters/Register, the suit "centers on when and how much insurers must pay in cases in which third-party insurance, such as automobile or homeowner policies, are used to cover emergency medical bills."
Plaintiffs in the suit are asking that the court require investigators to review a four-year span of patient records to determine which subscribers were denied coverage for emergency treatment.
Representatives for Health Net, Blue Cross and CIGNA said they could not comment because they had not seen the lawsuit.
Blue Shield spokesperson Elise Anderson said the company faces similar claims in a lawsuit filed in June. She said, "We are familiar with the suits that have been filed. ... We are reviewing the amended complaints and evaluating the steps to take."
Aetna spokesperson Fred Laberge said, "We are investigating the allegations, and we intend to defend (ourselves) vigorously" (Reuters/Orange County Register, 3/31).