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California Insurance Lawsuits Filed against Anthem Blue Cross

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Los Angeles, CACalifornia insurance lawsuits have been filed against Anthem Blue Cross, alleging policyholders were misled into canceling their insurance coverage. The lawsuit was filed after two plaintiffs were allegedly pressured into giving up insurance policies that should have been grandfathered in under new health care laws, and alleges violations under California insurance law.

According to the Los Angeles Times (11/4/13), approximately 900,000 people in California received notification that their health policies would be canceled. But lawsuits filed by Paul Simon and Catherine Coker allege that Anthem Blue Cross engaged in twisting, a violation of California insurance law. “Twisting” refers to the practice of convincing policyholders to give up their grandfathered plans.

The lawsuits, as noted by Courthouse News Service (11/6/13), allege Blue Cross convinced thousands of policyholders to leave their grandfathered health plans. Those health plans would have protected policyholders if the plans were purchased before March 23, 2010, and met the Affordable Care Act minimum requirements for coverage. Blue Cross allegedly did not inform policyholders of the risks associated with leaving a grandfathered plan. With the protection of a grandfathered plan, policyholders could continue with their coverage. Without a grandfathered plan, policyholders would have to purchase a new plan to replace their coverage, including potentially having a more limited provider network and leaving their current medical care providers.

Meanwhile, Blue Shield of California Life and Health Insurance Co. agreed to give policyholders until March 2014 before canceling their coverage. According to a press release from California Insurance Commissioner Dave Jones, individual policyholders could have had their policies canceled as of December 31. The insurance commissioner reportedly told Blue Shield that the company did not give policyholders enough notification of pending cancellation and threatened a lawsuit if more time was not given for policyholders to choose new policies.

“Allowing consumers to stay in their existing plans longer is the right thing to do for policyholders,” said Jones. “State and federal law allow Californians to keep their current policies beyond December 31. The existing policies are likely to have a broader network of medical providers, and for those who are not eligible for premium subsidies, a lower cost than what is available in 2014.”

Lawsuits have also been filed against insurers who unreasonably denied policyholders’ insurance claims.

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According to the booklet Evidence of Coverage, it states that when coordinating your care you should not delay your medical care while waiting for your PCP to grant you a referral. For 10 months, I have been going back and forth and my medical which is serious has been put on hold. My original pcp failed to follow through with the care that I need. Prior to the change in insurance, I had a PPO which allowed me to get the care I need--which I haven't gotten. I was seeing my specialists such as my neurologist for spine surgery, my gastroenterology for a serious condition, my pain management that handles my severe pain, and I need to see a E.N.T because I choke I everything. I also have growths on my lungs that have grown. This needs to be dealt with and not forgotten or ignore. According to the booklet,on page 35 it states that I can make an appointment with a specialist and then contact your pcp to inform them that I have seen a specialist. I have to see a hematologist due to my blood work dropping so low. I have had 2 bone biopsies. Doctor Black told me that if my hemoglobin drops below 9.5, I will need another bone biopsy. I have gone through hell and Doctor Malla saw me in the spring and has not followed through with the referrals. I have spoken to her and I have also spoken to the receptionists regarding these referrals. approximately 2 months after seeing doctor malla, I asked the receptionist if that had any word regarding my referrals. The receptionist told me that she hasn't even sent the request for the referrals. So, after 8 or 9 months, I am still not seeing any specialists. This doctor has failed me and also might contribute to my demist. This is unethical and not professional. Who's responsible if I have bone cancer or cancer of my lungs or my pancreas fails me considering that I have Monderate Pancreatic Atrophy. The booklet also states that if you are undergoing medical treatment you have the right to request and the insurance will work with me. Help. This is so horrible that my health is deteriating at the hands of Doctor Malla and also the insurer. The booklet also states that the insurer will work with me regarding my medical issues and that this care should not be interrupted. Thank

Posted by

2 things happen , I was forced into dropping my insurance with BC and going with Obama care I pick blue shield only because last NOV all my doctors were on their list. It turns out no only are none of my doctor excepting this insurance but in the valley I live only 12 do and I have to drive 60 to 100 miles for specialist.

Posted by

Anthem Blue Cross just sent me a "Certificate of Credible Coverage" with a "Cancel Date" of 03/07/14. Less than two weeks ago they told me over the phone that I was still covered. I've had a policy with them since the mid 1980's. Are any Class Action suits currently pending ? I consider this to be notice of cancellation received 04/05/14.

Posted by

Anthem has changed the new policy I purchased several times now. Same policy name and code, same premium, I have ail and documentation stating what the coverage should be. The coverage has now changed. First 20%, now 50%. All this for a 2014 plan since I signed up for it in October! I do not know what to do. The folks @ BC are just reading off a script. None of my medications are covered any more either. Others will be impacted s well.


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