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A group of California residents allege that they were lied to about what doctors they could use under new health insurance plans, what type of plans they were enrolling in and when they would start receiving benefits, according to a recently filed Anthem Blue Cross fraud class action lawsuit.
It is not the first case the company has faced regarding its handling of the switch thousands of customers from previous plans to those that comply with the Patient Protection and Affordable Care Act, commonly referred to as Obamacare. There are strict minimums for coverage at the Gold, Silver and Bronze levels and some insurers have taken to providing exclusive provider organization (EPO) plans to offset the costs.
The acronym may not be as commonly known as PPO or HMO, but it is a lot like the former. People can go see any doctor in-network without prior authorization. However, an EPO saves costs because there is no out-of-network coverage. Lead plaintiff Betsy Felser alleges that the company engaged in violations of the Knox-Keene Act requiring health insurance plans to be advertised accurately.
Felser’s claims are typical of those of the several plaintiffs. According to the class action lawsuit, she received a notice from Anthem Blue Cross regarding the need to switch to a plan compliant with Obamacare regulations. However, the health insurance class action lawsuit alleges that “unbeknownst to Betsy, the suggested plans were EPO plans, not PPO plans [like the one she had], and contained no out-of-network coverage or benefits.”
The letter, she alleges, did not note the change in plan type and when she contacted several staff members, they all said that it was a PPO plan and that her son’s pediatrician was covered. When she went to a health insurance agent to review these plans, the agent was allegedly unable to figure out the details. According to the Anthem Blue Cross class action lawsuit, it was not until she went to the pediatrician that she found out what type of plan she had truly received.
In addition to the alleged fraud regarding the marketing of these plans and the networks, other plaintiffs argue that because Anthem was unprepared for the massive switch, there were delays in getting out the insurance cards in a timely fashion. As such, customers were forced to pay out-of-pocket even with in-network doctors and specialists when that should have been unnecessary.
The plaintiffs are represented by class action attorneys Michael J. Bidart and Travis M. Corby of Shernoff Bidart Echeverria Bentley LLP and Jerry Flanagan and Laura Antonini of Consumer Watchdog.
The Anthem Blue Cross Fraud Class Action Lawsuit is Betsy Felser, et al. v. Blue Cross of California d/b/a Anthem Blue Cross, Case No. BC550739 in Superior Court for the State of California.
UPDATE July 25, 2016: A settlement has been reached in the Anthem Blue Cross Fraud class action lawsuit. Settlement specifics can be found here: https://felseranthembluecrossacasettlement.com/
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5 thoughts onObamacare Mishaps Spur Anthem Blue Cross Fraud Class Action
UPDATE July 25, 2016: A settlement has been reached in the Anthem Blue Cross Fraud class action lawsuit. Settlement specifics can be found here: https://felseranthembluecrossacasettlement.com/
Note: I live in IN, not Texas…..so I’m not sticking up for a former employer!
This happened to me however it was not with Anthem Blue Cross but rather Blue Shield of California. Although I did get enrolled in a PPO plan, I was blatantly lied to in regard to which physicians accepted said plan; meaning, when I asked on multiple occasions if I would still be able to see a certain doctor, I was assured that yes, I would be able to under the new plan. Since I was unable to log into the website to verify this information myself between the months of mid November 2013-March 2014 (when my new insurance card FINALLY arrived, three months late and without any accompanying plan documentation as promised and after me making about six phone requests and four requests online). Seeing that I had held an individual Blue Shield PPO plan for at least two years prior to this whole ACA thing, I really expected more from Blue Shield and have been fighting for adequate and marginally affordable coverage since. Sure, they did tell me I could keep my grandfathered plan but it would have cost me probably at minimum $2,500 more annually to do so and since I was reassured on multiple occasions that nothing would change, then would I stay with the more expensive option?! Furthermore, the fact that their member website was so inaccessible made it impossible for me to get any up to date provider information and even then, it was not always accurate. Therefore, when I called customer service, I expected them to give me the current provider status. If they did not know, they needed to state that, not merely say yet to get me off of the phone. Anyway, I will look into the more appropriate place to possibly share this information but figured I would leave a post here. I am seeking any sort of compensation. but I would like to see these companies held accountable for their shady practices.
Edit: I am NOT seeking any sort of compensation. Sometimes those fingers of mine get flying too fast when I’m typing about something I feel so strongly about and I leave out important words. Sorry for typo.
As an RN I can tell you the “bad” parts of Obamacare will not even start until after the election. I also was laid off by a tertiary, trauma one, University hospital, because I had 18 years of experience and made ‘Too much money”……They laid off 1000 nurses……Replaced by new grads at a lower wage ($10-35/ hour lower) who are clueless….well after all… who is there to precept and teach them?? However in their defense, they are also assured that they will not receive raises, not even cost of living…well they got a 1% pity raise + more responsibility and menial tasks because they cut housekeeping, secretaries, transporters and all other ancillary staff. Somehow they managed to make it impossible for us to even get unemployment pay….and ironically we, of course, lost our insurance! I now pay 1500+/month and have a $6000 deductible…..before I paid under $400/month (before taxes) and had no deductible for my family of 4. We are slowly losing all we worked for our entire life….since we live in a Republican state and no exchange was set up, private insurance isn’t even an option, it doesn’t exist in this state anymore……. There have been so many stories about the docs, and I do feel for them, but what about the nurses? We are unemployed…..or young and forced to take care of Ebola patients with NO training……no hazard pay, maybe life insurance x 1 year of their now, downsized salary!
But, don’t blame the hospital……As a tertiary and large, highly ranked hospital, we took care of the sickest of the sick, which meant most of them were already on Medicaid or Medicare or both. They were both drastically cut by the ACA and our incoming money, “profit” was reduced by more than 1/3! They don’t want you to know but most hospitals are struggling to make it…..They are becoming dangerous places because of reduced staff and knowledge. Don’t blame the hospital in Texas….Blame Obama….Before Obamacare, this would not have happened…Trust me. It’s just his way of punishing us because we are “bad”, because we are Americans. So sad. I really miss my old life….And I miss my patients…God knows why, but we do care about every last one….even those with Ebola.