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Anthem Blue Cross to Pay $8.3 Million to Settle Lawsuits

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Los Angeles, CAAnthem Blue Cross has agreed to pay $8.3 million to settle insurance lawsuits that alleged the company breached its contracts and engaged in unfair business practices. The settlement affects up to 50,000 Anthem Blue Cross customers who live in California and were affected by the company changing costs associated with individual policies. In agreeing to the settlement, Anthem Blue Cross did not admit liability.

According to the Los Angeles Times (10/27/15), two lawsuits were filed against Anthem Blue Cross, claiming the company illegally increased annual deductibles and other yearly costs mid-year. One of the plaintiffs in the case, Dave Jacobson, said his out-of-pocket maximum increased by $850 and his deductible increased by $25 partway through the year.

The insurer will mail notices to customers who were affected by the mid-year changes. Anthem has also reportedly agreed not to make cost increases midway through the year in the future. As many as 50,000 policyholders could be affected by the settlement.

Meanwhile, Anthem Blue Cross also faces a lawsuit alleging the company denied a policyholder necessary treatment because the insurer does not believe she is sick enough to require treatment. The lawsuit was reportedly filed by Marina Sheynberg, who alleged in her lawsuit that Anthem denied her medically necessary Harvoni treatment to treat her hepatitis C.

Hepatitis C is a contagious disease that can cause liver damage, infections and other serious health problems. Harvoni has been shown to be up to 95 percent effective in curing hepatitis C and reportedly causes few side effects. It is, however, an expensive medication with a 12-week course costing $99,000. As a result, some insurers have denied Harvoni treatment on the grounds that the patient’s liver is not sufficiently injured enough to justify treatment.

Lawsuits have been filed against insurers alleging they have repeatedly refused Harvoni treatment, despite having received information from doctors that the treatment was necessary for the patient. At least two other lawsuits have been filed against Blue Cross claiming the insurer is forcing patients to undergo significant damage to their liver before approving treatment.

The lawsuit is Sheynberg v. Anthem Blue Cross Life and Health Insurance Co., Case No. 3:15-cv-03417, in the US District Court for the Northern District of California.

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READER COMMENTS

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I am a stage 4 severe kidney disease patient with a rare compounding autoimmine disease that has not responded to every known treatment including chemotherapy up until my Renal doctor (a transplant surgeon at the practice as well) had perscribed a fairly new but fda approved gel injectiable drug called H.P. Acthar that United Health Care has stooped so low as to lie to pharmacies, doctors and others that I have not been making my monthly self pay healthcare.gov referral subsidized health insurance payments which is so false as I do pay them every 3rd of the month when social security direct deposits my disability pay. Being a forced into retirement insurance claims manager the 1st two months this occurred I spent 4 hours on calls attempting to get through to have the matter addressed so I could get my life sustaining anti-rejection medications on top of at least 12 more I must take daily. At first I was making on line payments directly on United Health Care website for 3 months with each and every beginning of the month resulting in countless delays in filling my meds even though the government and I are current on all payments. Going from an outsourced (guessing India) payment call center who can't see anything on their system about me or my account except amounts owed. So they bounce me off numerous other departments all who have a different story and supposedlyba different software so claims can't see billings info. And payment processing or customer service can't pull up claims. Eventually I get sent to billing who is allegedly the onky person who can see I in deed had made my payments timely but the issue is that UHC had never delt with direct customer payments in such quantity as Obamacare has created. So the on line bill pay software could not determine how to post your electronic funds transfer to any other month but the 1st month you were turned on. So for me loding medicade for making too much from social security disability (yet only Arizona has such stupidity in saying my 135% below poverty level at National level is too much money) so they cold dropped me with zero warning. Any rate united health care posted all these payments to February vs spreading them across 3 months hence supposedly causing the problem of saying I was not paying. Billing said in reply to my statement how do we keep this from occutng anymore and they said they would put a note in customer services system to say that I was being allowed a temporary exception so I could get my medicine filled BUT that there was no way to repair from billingband that I.T. would need to fox so after making my on line eft transfer to call customer service EVERY MONTH so they can get me to billing so another exception could be noted for customer satisfaction. So next month I decide I am not wasting 4-6 hours on the phone and will just pay by electronic funds transfer directly to the outsourcing payment center. Well upon doing so I am advised by a heavy foriegn (inda?) that she had to post my payment to the month before even though I told her the whole speal about their screw up in billing. Again United Health Care starts sending out denial letters and coverage cancelation notices to doctors and labs so now all my health service providers are demanding that I pay all my 3 month old bills UHC denied IN BAD FAITH plus the full retail cost of the treatment or labs. I cant afford to. And by the 5th and 6th month it becomes very clear that United Health Care is intentionally acting in bad faith on purpose so much so I finally fill out a 4 page department of insurance complaint against United Health Care as now itvhad been over a week without my life saving anti-rejection chemo based drug that United Health Care also demands I have to fill using their preferred mail order pharmacy which can never have it to me when I need it so more hoops and loop holes to get them to approve an emergency supply refill. Well turns outvtgisail order drug comlany is OWNED AND OPPPERATED BYBUNITED HEALTH CARE AS THEY BOUGHT OPTUM RX yet no where is this disclosed but for expensive drugs policybholder must use only their pharmacy ir they wont fill it period. No place in policy says this.
During this whole period I am speaking to numerous supervisors though the forgein call center always refused my request to speak to one because they didntbwant complaint costing them the account servicing. After 6 months of this endless run around I know damn well that this is a tatic in attempts to get me past a payment date so they can get rid of patients like me with cronic life threatening diseases like they would have done in the pre Obama health care reform days.
So finally nearly 2 weeks without most meds and making me bed ridden so sick while doing more than with drawls but causing permanent unreversable damage to my already weak kidneys further making remission a worth while battle to prevent a kidney transplant. I have suffered much mental anguish as well and have since been forced on heavy anti - depression meds as I had enough suffering for a lifetime plus I am a single father so the impact to my 9 year old son is also hard felt.
The department of insurance does use my bank statements to prove to United Health Care I am current and to make coverage immediately available as well retro active to original inception. Well form letter from insurance company appologize for their mistake of poor trained staff, temps or others mistakes and says I need do nothing and they will back pay all the denied claims they own which is impossible as for one many meds I had to pay Walgreens cash for so never got those back nor can either find them to rebill or refund. Additionally even with United Health Care admitting fault in wrongful denials they refuse to honor my request for EXTRA CONTRACTUAL OBLIGATION to pay my many specialists the full amount of contracted office visit at a $30 copay because of United Health Care making it so I could not go to my primary care doctor (that too was hell to fix as UHC assigned me to a primary care doctor who would not return my calls turns out that was because she was at a rest home not doctor office!) So instead of the referral rate deductible I am to pay $20 more per specialist if my primary doesnt referr me every month. Silly considering my renal doctor was taking care of me solely from blood pressure and thinning to hospitalizations, chemo, hormone replacement therapy injections and everything associated including weekly labs drawn at their office for years prior to joining united health care. Any rate so even on top of the increased copay for no referral United Health Care begins telling my doctors I owe $55-60 per visit for all 6-7 months that United Health Care made nearly impossible for me to get pre authorized referrals bevause they kept telling primary care doctors I wanted to use or try I had no coverage so I could not go to the primary care doctor to forfill United Health Care Insurance lower copay for specialist. On top of that my policy at sign up clearly stated that the copay with referral was $30 and imprinted on my insurance card and $20 more is noted in the policy itself BUT WHY DID UNITED HEALTH CARE RAISE IT TO 55 OR 60 WITH ZERO NOTICE IF RATE INCREASE? More bad faith.
So finally nearly 7 month of the yearvis gone and I have the ability to obtain a good primary care doctor while when they can United Health Care verify coverage in force and paid to date. Well this didnt last a month and now once again I am getting billing statements showing I'm.months behind and yet ive paid the last 4 to the customer service center in the USa . I also was told by a United Health Care employee that my 30-50 wait time for customer care was so rediculiously long it often would cut you off after long waits advising someone would call you back. Well the call back just sticks you back innthe sane que to do the same loop. However in playing with options and chosing customer service and claims for corporate employee paid insurance vs. Self pay insurance you would get almost zero wait time. I was told that united health care has made 2 teams one of experience and actually employed by UHC for corporate pay but self pay was temps, outsourcing etc and a much lower customer service intentionally (likely to discourage renewals of self pays who tend to be sick and cost more oer claim). Now comes the next denial in bad faith. My renal doctor and his team of 12 plus other kidney specialist doctors recommend that he perscribe me thevlast known treatment and the only treatment shown to offer remission of cronic kidney failure caused by auto immune attacks on my organs by boosting bodies own production of testosterone to fight off the disease. Well united health care has H.P. Acthar on their formulary list of covered drugs but requires pre authorization. As such the claims handler (not medically trained doctor) tricks the renal doctors medical assistant to send all my hippa protetected labs, failed drugs & chemo (one costing $100,000 a IV bag requiring hospitalization to administer and almost killed me from allergic reaction so can't use it further), my adema swelling severe I cant walk and joint pain rediculious, nausea vomiting daily , high redblood cell loss, hormone failure, phosphorus posioning, blood clotting , severe blood pressure over 200 and at stroke level,etc. Very important that I start Acthar treatment immediately. But united health care uses the doctors information just to deny drug treatment stating though it is a known effective treatment for cronic kidney disease UNITED health Care does not recognize this drug to treat my exact form. And as such the doctor info clearly proves this and even a second time through dept of insurance complaint against denial was appeal denied. So my doctor goes above and beyond and sends all my recirds, biopsies etc and gets tge pharmaceutical company to sponser me 100%;until medicare kicks in Dec 1 2015. Thinking all of the United Health Care games were behind me until I receive not only a past due balance statement again for November 2015 but a coverage denial letter for renal/kidney doctor office visit as not medically necessary because the doctors notes state a trial of H.P. Acthar to be adminstered so my September and October visits are denied payment as well as any or all office visits to the kidney specialist up through the future end of November irronc that's when Obamacare works for insurance company and forces disabled to switch to medicare. United is denying all office visits as unmedically necesssary treatments because they dont recognize a drug yet no one at said insurance company has any medical school training and eveb if they have their company owned pharmacy look over prescription that perskn could not of known drug as its newer. Besides united health care in bad faith took no bearing on the fact that my renal doctor does my red blood cell animeia hormone replacement therapy injections bi weekly in addition to weekly visits for warphine clinic blood thinning minitoring and other side effects caused by my cronic kidney disease. So to deny a treatment plan while banning, black mailing me to not use the dictor or practice that recommends such a drug as HP Acthar is a tatic to not pay what owed under the policy in force. They take no consideration for all the other treatments kidney doctor performs nor do the have 10 pus years of med school. Most claims adjusters have a bacholers degree in business and are in no way qualified to make or deny treatment for any disease. I am stuck in the middle of a power struggle between United Health Care and H.P. Acthar manufacturer. By the way this drug cost $68,000 for 2 tiny vails of .5 ml each I must self inject twice a week. I found the retail cost through medicare web site in switching to Cigna healthcare allnin one medicare plan next month. So guess United Health Care wins in getting rid of me that they have illegally done all year. Please help.

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