No More Out-of-Network Coverage for California Anthem Blue Cross Members

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Anthem Blue Cross delivered a blow to its California individual and family plan members at the start of the new year by stripping policies of out-of-network coverage. The worst part: most of these consumers don’t even know yet that they lost their out-of-network coverage for 2017.

As of January 1, Anthem converted its 2016 PPO (Preferred Provider Organization) health plans, which provide coverage for out-of-network doctors and hospitals, to EPO (Exclusive Provider Organization) health plans with no out-of-network coverage.

Many members are still likely unaware that their PPO plan is now an EPO because Anthem sent out misleading notices in September 2016. The notices promised PPO plan members that they would be automatically enrolled in the “same” or “similar” coverage for 2017 if they did nothing and just paid their premium in the usual fashion by December 15, 2016.

In reality, Anthem was rolling consumers into EPO plans, while increasing monthly premium costs by an average of 17%!

Contrary to what Anthem told its members, a PPO plan is not the “same” or “similar” to an EPO plan. With an EPO, members are essentially uninsured if they visit out-of-network doctors.

The harm to consumers is immeasurable. Members will get hit with huge, unexpected medical bills. Those who cannot afford to pay full price up front for out-of-network services will be forced to delay necessary medical care, putting their health and, in some cases, their lives, at risk. Most specialists are out-of-network, so sicker patients who need specialized care will suffer the most.

Consumer Watchdog sued Anthem over the practice.  In November 2016, we tried to block Anthem from moving its PPO plan members to EPO plans, but we were told by the Court that we could not seek relief until the harm had occurred.

The harm has now occurred. Consumers have lost their out-of-network benefits and are locked into EPO plans for all of 2017.

If you are enrolled in an Anthem plan for 2017 that does not provide the out-of-network coverage that you believed you were getting, please contact Consumer Watchdog and tell us your story.

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