This week, Consumer Watchdog filed two lawsuits alleging that Cigna and Blue Shield of California misled consumers who enrolled in their health plans about the size their provider networks, Kaiser Health News' "Capsules" reports (Appleby, "Capsules," Kaiser Health News, 9/25).
Previous Lawsuit Against Anthem
The new lawsuits come after Consumer Watchdog in July filed a similar class-action suit against Anthem Blue Cross alleging that the insurer misled "millions" of consumers who enrolled in its health plans about which physicians and hospitals were included in their provider networks.
Specifically, the lawsuit alleges that Anthem:
- Delayed giving its customers complete information until it was too late for them to switch their coverage choice;
- Did not inform its customers that it no longer offered out-of-network coverage in four of the state's largest counties — Los Angeles, Orange, San Diego and San Francisco; and
- Misled or did not inform its customers about which doctors and hospitals were participating in the insurer's new plans.
As a result of those alleged failures, the lawsuit states that many members received thousands of dollars in unexpected medical bills and were unable to see their preferred physician (California Healthline, 7/9).
Details of New Lawsuits
The new lawsuits allege that both Cigna and Blue Shield of California:
- Delayed giving their customers complete information until it was too late for them to switch coverage;
- Offered inadequate provider networks; and
- Presented inaccurate lists of participating providers ("Capsules," Kaiser Health News, 9/25).
In addition, the lawsuit against Cigna, which was not part of Covered California, alleges that the insurer sold its plans as if they were under the state exchange. It also alleges that Cigna switched some doctors to out-of-network status.
In its lawsuit against Blue Shield of California, Consumer Watchdog alleges that the insurer did not provide its customers with proof of insurance for two to three months, and sometimes longer (Romero, ABC7, 9/25). In addition, the lawsuit alleges that for some enrollees the nearest in-network physician listed on the insurer's website is 30 miles away ("Capsules," Kaiser Health News, 9/25).
Blue Shield of California acknowledged receiving the lawsuit, but provided no further comment. Meanwhile, Cigna declined to comment on the suit (ABC7, 9/25).