Marin Policyholders Applaud Suit Alleging Anthem Blue Cross Misrepresented Obamacare Plans

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Several Marin customers of Anthem Blue Cross Monday cheered on the efforts of a consumer watchdog group that has sued the California-based insurance giant for allegedly misrepresenting its new "Obamacare" plans.

Anthem Blue Cross misled "millions of enrollees" about whether their doctors and hospitals were participating in its new plans and failed to disclose that many policies wouldn't cover care outside its approved network, according to a class-action lawsuit filed last week in Los Angeles Superior Court by Santa Monica-based Consumer Watchdog.

The suit alleges that as a result many consumers are on the hook for thousands of dollars in medical bills and have been unable to see their longtime doctors. While declining to comment on the suit, Anthem has conceded that some doctors were inaccurately listed on its plans.

"When I signed up with Anthem, I got the most expensive policy for me and my son; it costs us over $1,300 a month. I did that so I could get the best doctors," said Shelley Brown of Tiburon. "I was never told that most of my Marin providers would not be covered."

Marianne Michael of Mill Valley said she was misled about which Marin doctors would be covered by the Anthem plan.

"One of the reasons that I went with the plan was I was told my general practitioner was in it and he was not," Michael said. "I was also told that my rheumatologist was in the plan and he was not."

John Murray of Corte Madera said, "When I signed up, they gave me every indication that the doctors we were currently seeing under our Anthem Blue Cross plan would be in the new plan."

But Murray said that proved untrue.

"When I hurt my leg, there was not one orthopedic doctor in all of Marin who would take it," Murray said of the Anthem plan. "I'm glad that someone is finally suing them."

Brought on behalf of Anthem enrollees who purchased individual coverage between Oct. 1, 2013 and March 31, 2014, the lawsuit reflects growing consumer push back against so-called "narrow network" health plans, which are increasingly common under the Affordable Care Act, commonly known as Obamacare. Anthem is a major player on California's health insurance exchange, and the suit includes those who bought coverage online, as well as directly from the insurer.

The suit says that Anthem, the state's largest individual health insurer, delayed providing full information to consumers until it was too late for them to change coverage. The suit also alleges that Anthem failed to disclose it had stopped offering any plans with out-of-network coverage in four of the state's biggest counties — Los Angeles, Orange, San Francisco and San Diego. Marin residents interested in participating in the suit may contact the Claremont-based law firm handling the case, Shernoff Bidart Echeverria Bentley, at 800-458-3386.

Anthem spokesman Darrel Ng said that Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year. However, he said, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed.

Anthem "intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share," said Jerry Flanagan of Consumer Watchdog.

The suit also alleges that Anthem subjected consumers to exceedingly long wait times, regularly lasting several hours, on customer service telephone lines when consumers called to address problems and misrepresentations.

Michael said, "It was impossible to get through to anyone. When I did, it would be someone in Florida who didn't know California regulations, which were different."

The suit comes as the consumer advocacy group is pushing a measure on the November ballot that would give the state's insurance commissioner greater authority to veto health insurance rate increases.

Insurers have defended plans with limited provider networks as a way of holding down premiums. Surveys have indicated that many younger and healthier customers are willing to give up broad access to providers for lower costs.

But consumers are retaliating with lawsuits and complaints to state regulators. As a result of the rising complaints, state managed care regulators are investigating whether Anthem and Blue Shield of California provided accurate information about the doctors and hospitals in their plans.

The Consumer Watchdog lawsuit names six Californians who purchased Anthem plans. Among them is a Pasadena physician, Betsy Felser, who had coverage with Anthem for 20 years. Like hundreds of thousands of Anthem customers, she received a letter late last year stating that her preferred provider organization, which allows for in- and out-of-network care, was being canceled, according to the lawsuit. The letter suggested a replacement Anthem plan "with the benefits you have come to count on."

Before agreeing to switch, Felser said she checked with five Anthem telephone representatives, making it clear she wanted to be in a PPO.

"I would never have gotten anything that wasn't a PPO plan," said Felser, 47, whose insurance also covers her young son. "They said they would give me the same coverage."

During those calls, none of Anthem's representatives told Felser that the insurer was no longer offering PPOs in Los Angeles County, the lawsuit alleges. Nor did they tell her that the Anthem plans offered in her area would not cover care provided by out-of-network doctors or hospitals, according to the lawsuit.

Marin Independent Journal writer Richard Halstead and Bay Area News Group writer Tracy Seipel contributed to this report. Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

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