Anthem, the second largest health insurer in the nation, is facing a class action lawsuit for allegedly misleading thousands of Georgia consumers during the 2018 open enrollment period.
The lawsuit against Anthem/Blue Cross and Blue Shield of Georgia alleges consumers were misled that they would continue to have in-network access to the doctors and specialists of Georgia’s largest healthcare provider, WellStar Health System. Consumers were misled by omissions and misrepresentations by the insurer, according to the suit, which was filed by the Doss Law Firm.
WellStar's in-network contract with Anthem ended Feb. 4. Anthem issued a 90-day extension for health members to continue receiving services from WellStar under in-network rates.
“Despite the fact that Anthem informed WellStar in August 2018 that it would not be including WellStar as an in-network provider for its individual health plans during the 2019 coverage period … Anthem never informed consumers of this fact and engaged in a deceptive marketing scheme to continue to list WellStar providers as in-network during the open enrollment period,” stated the lawsuit, which was filed in the U.S. District Court for the Northern District of Georgia Atlanta Division on behalf of Frances Kirby and John David Marks.
Anthem recently faced a $115 million settlement for a data breach that exposed the personal information of millions of people in 2015. The insurer also faced a lawsuit from a group of doctors over its billing practices for emergency room care.
“It has come to our attention some consumers may have enrolled in Anthem plans based on the incorrect assumption WellStar would remain in our Pathway network throughout 2019," Anthem said in a statement to HealthExec. ... "We are extending benefits for 90 days to Pathway members who selected, were assigned or attempted to choose a WellStar affiliated primary care physician. This means the impacted Anthem Pathway Member can receive treatment from WellStar PCPs until May 4, 2019, and Anthem will allow the previously contracted reimbursement rate, although we cannot guarantee WellStar will permit Pathway Members to schedule appointment, or will not bill members for the difference between the Anthem allowed reimbursement and WellStar’s billed charges."
WellStar declined to comment.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."