Anthem Blue Cross Faces Class-Action Lawsuit Over Alleged Fraudulent Enrollment Practices

A class-action lawsuit has been filed against Anthem Blue Cross alleging the company provided misinformation to millions of insurance enrollees concerning out-of-network coverage and in-network provider lists.

Since January, Anthem has been the subject of 115 provider-related complaints from consumers. Last month, in response to the complaints, California state regulators began an investigation into Anthem concerning the inaccurate in-network provider lists.

Anthem acknowledged that mistakes were made with respect to the in-network physician lists it provided to many of its members, and the insurer said it had repeatedly attempted to contact physicians to determine their network status.

As a result, Anthem agreed to pay the claims of its members who received care during the first three months of this year from physicians who were inaccurately listed on the provider lists they were given, according to a Kaiser Health News report.

In addition to providing inaccurate in-network physician lists, the class-action lawsuit alleges newly enrolled Anthem members were not told their plans would not cover care outside of their approved networks.

The lawsuit alleges Anthem did not disclose to consumers that it had stopped offering any plans with out-of-network coverage in four of California's largest counties until it was too late for the consumers to change coverage.

The lawsuit reflects growing consumer pushback against narrow network health plans. Anthem Blue Cross and Blue Shield's narrow networks in New Hampshire, Maine and Missouri have already received criticism, with some policymakers and excluded providers saying the narrow networks could limit access to care.

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