Lawsuit Filed Against Anthem Blue Cross of California for Misrepresenting Networks to Its Members

August 21, 2014   Business News
(PRLEAP.COM) Thirty-three members of Anthem Blue Cross of California filed a lawsuit yesterday against Anthem to end to its practice of misleading its members regarding their coverage and the providers within its network, according the Scott Glovsky, the lead attorney for plaintiffs. Download a copy of the complaint here: http://www.scottglovsky.com/wp-content/uploads/2014/08/Anthem-Complaint-8-19-14.pdf

The suit alleges that Anthem's website has consistently listed providers who are not in-network providers. In addition to online misrepresentations, Anthem has directly misrepresented over the phone to members the doctors who are in Anthem's network. Members end up paying costly monthly premiums believing that they are entitled to services which, in reality, are not available to them, according to Glovsky.

"Without telling their members, Anthem switched thousands of their loyal members into extremely limited Obamacare networks. So overnight, Anthem took away access to the doctors who their members have trusted for years. Many members did their homework and only enrolled after confirming with Anthem that their doctors were covered. Then, after enrolling, they learned that their doctors were not covered. Anthem pulled a bait and switch, and many people feel betrayed," according to Glovsky.

Anthem also recently issued many member identification cards which incorrectly state that members are in Preferred Provider Organization ("PPO") plans when, in fact, they are enrolled in Exclusive Provider Organization ("EPO") plans. The difference between these similar-sounding plans is critical. In PPO plans, members have access to a huge network of Anthem providers and the ability to obtain covered treatment from out-of-network providers. Unlike PPO plans, in EPO plans, members only have access to an extremely limited network of providers and no coverage for out-of-network providers.

These faulty membership cards are so clearly deceptive that even health care providers frequently mistake them for PPO plans, when they are actually EPO plans. Thus, when a member provides their misleading member identification card to an Anthem PPO provider, often the providers will go ahead and render services, believing fully that the members are in an Anthem PPO plan and will be compensated for their medical costs. As a result, the member receives services from these providers only to have Anthem ultimately deny coverage on the ground that the providers are not in-network EPO providers. In this way, Anthem has wrongfully forced potentially thousands of their members to pay out-of-pocket for medical costs.

The plaintiffs in this case are just a few of the people struggling with a similar predicament. Lead attorney Scott Glovsky says, "Anthem has an obligation to make it clear which doctors and providers are in subscriber networks and when it fails to do so, as it has done with its EPO subscribers, it has an obligation to cover the treatment."

About The Law Offices of Scott C. Glovsky
The Law Office of Scott Glovsky is a boutique Pasadena firm with a practice focusing on cases against health insurance companies for the wrongful denial of care. The firm's civil litigation practice focuses on health insurance bad faith, representing children with autism, traumatic injuries, unlawful business practices, and class actions. For more information, go to: www.scottglovsky.com
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