An Atlanta law firm filed a lawsuit under the ACA that seeks to allow thousands of individuals with Anthem Blue Cross coverage to get a special enrollment period after they were "falsely" lured into plans that didn't include certain providers, according to a March 4 complaint.
Five things to know:
1. The complaint, which amends a class-action lawsuit filed by the Doss Firm Feb. 5, claims that Anthem made "multiple false marketing claims" that "lured thousands of Georgia consumers into" its ACA individual plans. Specifically, Anthem falsely advertised that Marietta, Ga.-based WellStar Health System and Atlanta-based Emory Healthcare would be in the health insurer's network, according to the allegations.
2. Additionally, the law firm accused Anthem of falsely inflating the size of its physician and hospital network, and "improperly reversing its marketing promise that consumers would not be required to seek referrals before seeing specialists."
3. Anthem's alleged actions have put policyholders' lives at risk, the law firm claims. They cited one story of a 27-year-old Georgia resident who suffers from postpartum cardiomyopathy and a form of tachycardia, and requires a heart transplant to survive. The woman claims she confirmed her new individual Anthem plan network included WellStar and Emory, the latter being the only hospital in Georgia able to perform her heart surgery; however, she later found out the providers were out of network.
4. In February, Anthem issued a 90-day reprieve for members to maintain access to some services, such as primary care, at in-network prices until May 4. The change came after the Georgia Department of Insurance prodded the insurer.
5. In an emailed statement to Becker's Hospital Review, Anthem Blue Cross said it is "aware some members enrolled in individual Guided Access HMO plans received information after enrolling that contained an error, and the company has taken steps to try and correct the situation. Although several consumer-facing materials correctly stated that the Pathway X Guided Access HMO plan generally requires referrals for specialists, the member contract these consumers received contained a mistake. In that document, there were three primary references to specialist referrals: two instances stipulated correctly that referrals from primary care physicians are generally required, while a third reference incorrectly stated a referral is not required."
The statement continued: "Anthem notified the Department of Insurance upon discovering the error, and letters were sent to the impacted consumers explaining the situation. It's important to note Anthem has not changed the benefits under the contract for this individual coverage plan."