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Anthem Sued for Misrepresentations of Coverage in Obamacare "Open Enrollment Period" That Begins Today, Says Consumer Watchdog

Wednesday, November 2, 2016 Medico Legal News J E 4
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SANTA MONICA, Calif., Nov. 1, 2016 /PRNewswire-USNewswire/ -- Consumer advocates announced a lawsuit today to block Anthem from terminating its individual PPO health plans in California currently scheduled for January 1, 2017.

Anthem Blue Cross is claiming to 'renew' coverage for 2017 when in fact it is not adequately informing consumers that the new plans provide no coverage if a physician is not participating in Anthem's network.

"Anthem is breaking the law and its promises to consumers by attempting to automatically 'renew' its 2016 members for 2017 in coverage that actually provides no out-of-network care whatsoever. In an effort to retain its market share, Anthem is failing to adequately inform its members that they are losing out-of-network benefits for 2017," said Laura Antonini, staff attorney for Consumer Watchdog.

This change leaves customers potentially facing thousands of dollars or more in medical bills that their existing plan covered, without them knowing it. Many consumers likely face loss of access to their physicians altogether, a prospect particularly harmful for those in the midst of treatment, as paying full cost of out-of-network care is untenable for all but the wealthiest.

Click here to download the new class action lawsuit: http://tinyurl.com/hlsf4zk 

Urgent action by the court is necessary to protect California consumers as the "Open Enrollment Period" for securing health plan coverage for 2017 begins today. Consumers who renew their Anthem coverage by the December 15 deadline will be locked into those plans for all of 2017.

The California class-action lawsuit filed on behalf of Anthem enrollees by attorneys for Shernoff Bidart Echeverria LLP and Consumer Watchdog targets Anthem for characterizing and marketing its 2017 individual and family health plan contracts as a "renewal" of its 2016 plans despite changing the plans from "Preferred Provider Organization" or "PPO" plans, which offer out-of-network benefits, into "Exclusive Provider Organization" or "EPO" plans, which provide no out-of-network benefits. The premiums for the new plans are also going up.

The lawsuit announced today alleges that Anthem violated federal and state laws by:

  • Breaching its health plan contracts with its 2016 members by failing to provide "guaranteed renewal" of existing coverage as required under the contract.
  • Attempting to automatically "renew" members currently enrolled in PPO plans into EPO plans as of January 1, 2017, rather than correctly disclosing to consumers that Anthem is discontinuing their 2016 coverage. (The lawsuit alleges that the transformation of the plans into EPO plans renders the 2016 PPO plans "discontinued.") 
  • Sending out misleading "renewal" notices rather than "discontinuation" notices that would adequately inform 2016 members of the loss of out-of-network benefits for 2017.

"We believe that Anthem is trying to take advantage of consumers during the Open Enrollment Period," said Travis Corby of Shernoff Bidart Echeverria LLP. "They are selling 2017 Affordable Care Act health plans as being the same as their 2016 products. But they are not adequately informing consumers that the new plans provide no coverage if a physician is not participating in Anthem's network. Existing customers are being completely misled, and will potentially face thousands of dollars or more in medical bills that would have been covered under their existing plan. Many consumers likely face loss of access to their doctors altogether."

The Consumer Watchdog and Shernoff Bidart Echeverria LLP lawsuit seeks to require Anthem to renew the PPO health plans subject to the action for the 2017 calendar year, and demands reimbursement of money paid by consumers that will result from Anthem's illegal acts.

"We are caught in a double bind. Many of my family member's doctors are specialists that are out-of-network under our current Anthem PPO plan — which is why we purchased a PPO in the first place!" said Leslie Burkes, an affected Anthem consumer. "Under a PPO, Anthem pays for out-of-network doctors. If Anthem is allowed to convert these plans to EPO plans we will have no coverage for the doctors we need. Furthermore, we cannot switch to another health insurer because Anthem's care management team has been managing my family member's complicated health needs for the last year. Changing companies now would severely impact my family member's health because a new team of staff would have to learn about my family member's complex needs and history."

The Consumer Watchdog and Shernoff Bidart Echeverria LLP lawsuit, Simon v. Anthem Blue Cross of California (Case No. BC639205), was filed in Los Angeles County Superior Court. 

Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. Find us on the web at: http://www.ConsumerWatchdog.org

Shernoff Bidart Echeverria LLP leads the nation in protecting policyholders from insurance company abuse. The firm has been protecting the rights of insurance consumers, both individuals and businesses, for over 35 years after having set the legal precedent requiring insurance companies to act in good faith. For more information, go to: http://www.shernoff.com

 

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/anthem-sued-for-misrepresentations-of-coverage-in-obamacare-open-enrollment-period-that-begins-today-says-consumer-watchdog-300355243.html

SOURCE Consumer Watchdog

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