The most recent lawsuit was filed by Jonathan Brown and 32 other policyholders in California court against Blue Cross of California (doing business as Anthem Blue Cross), Courthouse News Service (8/20/14) reports. The lawsuit alleges breach of contract and unfair business practices against the insurance company. Plaintiffs allege Anthem’s website and customer service misrepresented which doctors were included in care plans and policyholders only found out after they enrolled in individual plans that their doctors were not covered.
Policyholders often choose their health insurance based on the list of doctors, hospitals and specialists included in the insurance provider’s network.
According to an article by the Huffington Post (8/19/14), some insurers include “skinny health care networks,” in which doctors that are listed are not actually taking new patients, doctors are listed who are not actually in the network, or only providers that are far away from where patients live are included.
Furthermore, the lawsuit claims policyholders were sent membership ID cards that indicated the policyholders were enrolled in the Preferred Provider Organization plan when they were in the Exclusive Provider Organization plan. The Preferred plan reportedly has a large network of providers and out-of-network care, while the Exclusive plan has a limited number of providers and no coverage on any out-of-network care.
Policyholders who received their cards believing they were in the Preferred plan then reportedly received services from physicians they thought were included in the network only to find out after the fact that their providers were not covered and the policyholders were forced to pay out-of-pocket for services.
Although Anthem Blue Cross has said it did nothing wrong, a lawyer for the plaintiffs said individual members had their networks changed overnight, suddenly forcing them to use new doctors.
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Anthem Blue Cross faces a different lawsuit (case number BC 5490438, Superior Court for the State of California, County of Los Angeles) also alleging that policyholders had their policy changed without warning. In her lawsuit, Samantha Berryessa Cowart alleges she believed she was enrolled in the Preferred Provider Organization when in fact she was in the Exclusive Provider Organization. She says she only discovered the issue when her claim was not approved, leaving her to pay for the medical treatment.