Georgia's insurance commissioner issued an order May 10 that requires Anthem to testify at a hearing over its dispute with Marietta, Ga.-based WellStar Health System.
In the 12-page order, Insurance and Safety Fire Commissioner Jim Beck accused Anthem of unfair trade practices and possibly violating state law. According to Mr. Beck, although Anthem notified WellStar in August 2018 that the insurer planned to cut ties with the health system for its individual exchange plan, Anthem "inconsistently and inaccurately" said WellStar providers would be in network for the 2019 plan year.
WellStar, which comprises nearly a dozen hospitals, three health parks and 10 urgent care clinics, initially was no longer considered in network for Anthem's individual policyholders after a contract expired Feb. 4. The change did not affect members with employer-based coverage, but those who purchased plans off individual exchanges like those set up by the ACA.
After a 90-day extension on the contract, plan members officially lost in-network access to WellStar May 4. The commissioner issued his order amid "numerous" complaints from members, a group of whom also filed a February class-action lawsuit against the insurer over the dispute.
Should Mr. Beck find Anthem engaged in unfair trade practices after the hearing, the health insurer could face fines or other ordered relief, according to the commissioner's office. The hearing is scheduled for May 29 in Atlanta.
In an emailed statement to Becker's Hospital Review, Anthem said it "has worked closely with Commissioner Beck and the Department of Insurance throughout 2019 to assist consumers who wrongly assumed WellStar would be in the Pathway network. Anthem has provided numerous options to help those consumers, and Anthem will continue to work with the Commissioner on these issues. With respect to the Commissioner's request for a hearing, Anthem will be present at the hearing and present information that makes clear that Anthem has done nothing that is misleading, unfair or deceptive. Anthem will continue to work to ensure our members receive high quality, affordable care through our network of participating providers and hospitals."
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