LOS ANGELES (CN) - Anthem Blue Cross deprives thousands of Californians access to their doctors by dumping members into limited Obamacare plans, 33 policyholders claimed in court Tuesday.
Jonathan Brown et al. sued Blue Cross of California dba Anthem Blue Cross, in Superior Court.
Suing as individuals, the plaintiffs seek damages for breach of faith, breach of contract, unfair business practices and negligence.
Since late last year, according to the 47-page lawsuit, the Anthem website and its customer service representatives have "systemically misrepresented" that certain doctors are available to subscribers under individual plans.
"As a result, in reliance on Anthem's misrepresentations, many individuals enrolled in Anthem individual plans only to ultimately learn that the doctors on which they rely were not covered," the lawsuit states.
Brown claims that Anthem dumps members into "'skinny'" healthcare plans that insurers created for the Affordable Care Act, or Obamacare.
"In other words, Anthem tricked their individual subscribers out of their existing Anthem networks (and physicians) and transferred them into skinny networks without access to the providers on which they have relied for years or decades," the complaint states.
In an Aug. 19 article on "skinny health care networks," the Huffington Post reported that skinny networks may exclude doctors that members rely on, may list doctors who are not taking new patients, may exclude key care facilities, or include only clinics far away from where patients live, forcing them to forgo treatment or pay for out-of-network care.
The Los Angeles Times reported in June that officials at the California Department of Managed Health Care were investigating allegations that Anthem Blue Cross and Blue Shield of California violated state law in connection with its offerings of skinny or limited healthcare plans under Obamacare.
In the lawsuit, Brown claims that Anthem fills its coffers by taking a two-prong approach, excluding more expensive providers from individual networks and offering the remaining providers bargain-basement reimbursement rates.
"As a result, and as expected, many of the remaining providers refused to participate in the individual networks," the lawsuit states.
Brown claims that Anthem mails members ID cards stating that they are Preferred Provider Organization members, though they actually enrolled in Exclusive Provider Organization plans.
The differences between PPO plans and EPO plans are stark. PPO plans offer a "huge network" of providers and out-of-network care, while EPO plans limit the menu of providers, and offer no coverage for out-of-network care, according to the complaint.
"When the members provide their member identification cards to Anthem PPO providers, the providers render services believing that the members are in an Anthem PPO plan. As a result, members receive services from these providers, only to have Anthem ultimately deny coverage on the ground that the providers are not in-network EPO providers. Thus, Anthem has wrongfully forced potentially thousands of their members to payout of pocket for medical costs," the complaint states.
It adds: "In sum, Anthem has developed a new population of members that are the 'insured-uninsured.' These members are insured in that they pay substantial premiums for health insurance, but they are uninsured in that they cannot access the providers that they need. As a result, Anthem profits while these members cannot access services."
In an email to Courthouse News, Anthem Blue Cross spokesman Darrel Ng said the insurer has issued new ID card to subscribers to remedy the issue.
"Blue Cross Blue Shield Association rules, dating back to the 1990s and relating to urgent or emergency care in other states, required Anthem Blue Cross to include the designation in question on ID cards," Ng wrote. "Anthem Blue Cross subsequently requested and received a waiver from the rule and has issued new ID cards. Materials at the time of enrollment and in member's Explanation of Benefits have clearly stated that the plan was an EPO plan which may not have out of network benefits."
Ng noted that Blue Shield of California had faced similar legal claims over limited Obamacare plans.
The plaintiffs seek costs, restitution and damages.
They are represented by Scott Glovsky, of Pasadena, who wrote in an email to Courthouse News that the court filing represents his clients' "outrage" and accused Anthem of pulling a "bait and switch."
Noting that Anthem had switched existing individual members to Obamacare networks without telling them, he said that "overnight" the insurer had stripped members of doctors they had "trusted for years."
"Many members did their homework and only enrolled after confirming with Anthem that their doctors were covered," Glovsky wrote. "Then, after enrolling, they learned that their doctors were not covered. Anthem pulled a bait and switch, and many people feel betrayed and want justice."