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Anthem Sued for Illegally Stripping Out-of-Network Coverage for Californians

Wed, 01/18/2017 - 19:41
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Paul Simon v. Blue Cross of California d/b/a Anthem Blue Cross, Los Angeles Superior Court Case Number BC639205

A California class-action lawsuit was filed on October 31, 2016 on behalf of California Anthem enrollees by attorneys for Shernoff Bidart Echeverria LLP and Consumer Watchdog targeting 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 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.

Download the complaint here: http://www.consumerwatchdog.org/resources/class_action_complaint__demand_for_jury_trial_10-31-16wo_exhibits.pdf

In November 2016, the Plaintiff tried to block Anthem from moving its PPO plan members to EPO plans, but  was told by the Court that he could not seek relief until the harm had occurred. The lawsuit is ongoing.

Read the press release announcing the lawsuit here: http://www.consumerwatchdog.org/newsrelease/anthem-sued-misrepresentations-coverage-obamacare-“open-enrollment-period”-begins-today

Watch a video about the lawsuit here: http://www.consumerwatchdog.org/video/anthems-bait-switch