Anthem Blue Cross’s “Bait & Switch” Misrepresentations of Doctor & Hospital Networks, and Delayed Enrollment in Affordable Care Act Plans

    Felser, et al. v. Blue Cross of California, Los Angeles Superior Court Case No. BC550739

    Consumer Watchdog has filed a class-action lawsuit on behalf of hundreds of thousands of California consumers against Blue Cross for misrepresenting its physician and hospital networks in order to boost sales during the Affordable Care Act’s first ‘open enrollment period’ that ended on March 31, 2014.

    Additionally, the lawsuit alleges that Blue Cross violated California laws by:

    • Subjecting consumers to inadequate networks of physicians and hospitals, causing delays and interruptions in accessing needed health care;
    • Misrepresenting so-called “Exclusive Provider Organization” aka “EPO” health plans that are similar to HMOs, with no out-of-network coverage and benefits, as Preferred Provider Organization (“PPO”) plans, which provide out-of-network coverage and benefits;
    • Misrepresenting and concealing that its new PPO plans imposed much higher deductibles for out-of-network providers than advertised for the plans.  As a result, consumers must pay far more out-of-pocket before Blue Cross pays for medical care;
    • Delaying consumers’ enrollment in new health plans for months, effectively blocking access to physician and hospital services, even though Blue Cross collected consumers’ premiums; and
    • Subjecting consumers to exceedingly long wait times, regularly lasting several hours, on customer service telephone lines when consumers called to address these problems and misrepresentations.

    The lawsuit seeks to require Blue Cross to establish sufficient provider networks and administer health plans in compliance with California law, and demands reimbursement of money paid by consumers as a result of Blue Cross’s illegal acts.

    Download the lawsuit here.

    Read the press release announcing the lawsuit here.