Impatient

Helping make the health care system work for you

Has your health insurer misled you?

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52879 full

Have you felt mistreated by your insurance company? We want to hear from you.

KPCC health care Correspondent Stephanie O’Neill reports that a consumer group has filed a class action lawsuit accusing Anthem Blue Cross of fraud and unfair business practices, "allegedly intended to lure customers into buying its health insurance plans."

The details

O’Neill writes:

The lawsuit, filed Tuesday in Los Angeles County Superior Court by Consumer Watchdog and Anthem customers, accuses the insurer of  "deceptive 'bait and switch' misrepresentations," among other things. (Another consumer's lawsuit filed in June makes similar accusations.)

The lawsuit alleges that Anthem:

  • Misrepresented to consumers that their physicians and hospitals were participating in Anthem health service plans;
  • Misrepresented Exclusive Provider Organization (EPO) health service plans, with no out-of-network coverage and benefits, as Preferred Provider Organization (PPO) health service plans, which provide out-of-network coverage and benefits;
  • Offered inadequate networks of physicians and hospitals, delaying and interrupting care;
  • Delayed customers' enrollment in new health service plans for months, effectively blocking access to physician and hospital services;
  • Subjected consumers to exceedingly long wait times, regularly lasting several hours, on customer service telephone lines.

One patient's story

Does any of that sound familiar to you? It does to Patricia Griffin, a retired Orange County lawyer and plaintiff in the case.

Griffin says Anthem sent her several letters, informing her that her existing PPO plan would be cancelled by March 31 – the end of open enrollment – and that she needed to move to a plan compliant with the Affordable Care Act by April 1.

She says that Anthem offered her a new plan, and she called the company several times to confirm that it was a PPO, and that it covered her doctors, including her cardiologist and other specialists.

"I told them what doctors I treated with, they had my computer screen up, they knew my history," she says. "They assured me I was getting into a PPO. They sent me a card that said I was in a PPO."

But when she fell and hurt her knee and went in for her surgical pre-op appointment, she was told she'd have to pay out of pocket because her surgeon was no longer in the network.  She says she later discovered her plan wasn't a PPO, but was actually a limited EPO that would not cover any treatment except from those doctors who were listed as participants in her area.

None of her doctors, Griffin says, are included in the company's Orange County plan, which, she says, costs her $917 a month "to be basically uninsured."

Insurer responds

In response to the lawsuit, an Anthem Blue Cross spokesman provided this statement to KPCC:

"Anthem Blue Cross continually works to improve the accuracy of our provider directory. In the process of updating our provider database earlier in the year, we found that while the vast majority of the listings were correct, there were some providers inadvertently listed. Many of the doctors inadvertently listed decided to join Anthem's network for individual members. Overall, Anthem has added more than 3,800 doctors to our statewide exchange network since Jan. 1. 2014."

"Members having an issue finding a provider should call the customer service number on the back of their ID card, and our customer service team will assist in finding an available provider."

Widespread concerns?

State health regulators are investigating whether Anthem -- and Blue Shield of California -- violated state law by publishing inaccurate provider lists and failing to offer timely access to treatment.

We really want to hear from you. Have you had similar problems with Anthem, Blue Shield or another insurance company?

Tell us about it in the comments section below, or e-mail us at Impatient@scpr.org.

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