A group of 33 Anthem Blue Cross members have filed a lawsuit against the insurer in Los Angeles County Superior Court alleging the company misrepresented the size of its physician networks and the benefits provided under the plans it offered under the Patient Protection and Affordable Care Act, according to a report by the Los Angeles Times.
The lawsuit alleges Anthem Blue Cross — a unit of WellPoint — cancelled some consumers' PPO plans and moved them to an exclusive-provider-organization policy. As a result, some members incurred unexpected medical bills when they went to out-of-network physicians, since EPO health plans provide very limited or no coverage outside the network, according to the report.
The lawsuit also claims the insurer provided misleading or incorrect information to some of its members last fall and this year concerning the participating providers in their new plans.
This is not the first time Anthem has been subject to this type of complaint. In July, a lawsuit seeking class-action status was filed against the insurer claiming Anthem provided consumers with inaccurate in-network provider lists and that new members were not informed that their policies would not cover care outside of their networks.
Anthem is yet to respond to the most recent lawsuit, but has defended its conduct and stated the explanation of benefits provided to members at the time of enrollment stated the plan was an EPO, according to the report.
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