Patients file class-action lawsuit against Anthem over WellStar dispute

Anthem policyholders are filing a class-action lawsuit against the insurer after it did not tell members it planned to go out of network with Marietta, Ga.-based WellStar Health System before they locked into individual health plans for the year, according to the Atlanta Journal-Constitution.

Five things to know:

1. WellStar, which comprises nearly a dozen hospitals, three health parks and 10 urgent care clinics, 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.

2. However, 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.

3. At issue, and at the center of the lawsuit, is the allegation that Anthem members chose their policies in fall 2018, at which point Anthem already knew it was ending its WellStar contract for individual members. The class-action lawsuit claims Anthem tricked members into applying for the plans, only to learn through their physicians and news stories that WellStar, one of the biggest systems near Atlanta, would not be considered in network.

4. WellStar officials plan to continue treating primary care visits as in network during the reprieve, according to the Atlanta Journal-Constitution. However, when Anthem treats patients as out of network for other services, WellStar will balance-bill patients for the remainder. WellStar said it will consider the price of the service to be the lower network price and not the public list price.

5. Anthem and WellStar are slated to mediate their contract dispute in March as part of their agreement, according to the report.

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