California insurance giant 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 Tuesday.
As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.
http://www.kaiserhealthnews.org/...
Oh, well, this kind of stuff probably only happens in California...
From Illinois:
In March, I searched through the healthcare marketplace, spoke to a representative of both the market place and BCBSIL, and found what I thought was a good plan. I chose the Blue Choice PPO Silver 003 plan. I was told by the BCBS rep that I would not have to change doctors because I was choosing a PPO plan. That was great. I love my doctor. So I signed up. Paid my premium. A month and a half later in May, I went to the doctor, who then sent me to see a muscular specialist. Then in June, I received a notice from BCBS and from both doctors offices that my visits were not covered and that I owe the full balance.
I contacted BCBS on June 23, only to be told that the "CHOICE" PPO has a "limited network" of doctors that I can see. I explained the above to the customer service rep (person 1) who then sent me to a (2) claims specialist, who then sent me to a (3) sales rep to change my plan but the sales rep said that I could not change plans until November (so I asked for a supervisor). He then sent me back to (4) customer service (where again I asked for a supervisor), who then sent me to (5) claims agent again, who finally, when I asked to speak to a supervisor (this is at about the 2 hour mark), forwarded my call, NOT to a supervisor, but to a (6) healthcare.gov rep. Completely out of the BCBS bounce house, the healthcare.gov rep was awesome. She actually listened to me and changed my plan.
During my bounce around of 2 hours of holding and sporadically speaking to people who had no clue why I was forwarded to them, I gained very little information other than the plan I was on only allowed me to see a small number of providers that were "in network for my plan". When I asked them why it was labeled a PPO and not an HMO, and that before I finalized my purchase on the healthcare website that THEIR rep told me I would be covered, they said the rep must have misunderstood the plan.
http://www.consumeraffairs.com/...
Wow. The ACA is sure causing some stellar insurance companies to go bad. I wonder if my patients have been telling me the truth. Several of them have complained that when they signed up, the BCBS rep told them they could keep seeing me and their other doctors, but when they got their card, they discovered there were just two family physicians in the area that were taking their new insurance. I know that a lot of people at Kos insisted that I must have hallucinated the whole thing--no insurance as reputable as BCBS would ever play bait and switch with a member. Ever. Except in California. And Illinois.
I'll bet things were never like this for BCBS before the ACA made health care so complicated...
Minnesota v. Blue
Cross Blue Shield of
Minnesota
The Minnesota Attorney General filed a lawsuit against Blue
Cross Blue Shield of Minnesota alleging that it violated state law
by engaging in a “pattern of misconduct in denying medically
necessary health care treatment recommended by physicians
for Minnesota children and young adults suffering from mental
illness, eating disorders and chemical dependency.” According
to the complaint, Blue Cross Blue Shield of Minnesota shifted
costs to taxpayers and/or families by telling subscribers’ children
to seek help through the juvenile justice system rather than
receive health care treatment covered under a Blue Cross Blue
Shield policy. The complaint also alleges that defendant denied
or limited coverage for medically necessary treatment after
mere “paper reviews” and misrepresented and omitted material
facts regarding coverage. The lawsuit seeks declaratory and
injunctive relief, civil penalties and restitution for injured
consumers. Blue Cross and the Attorney General settled this
case in August of 2001
Telling parents to send their kids to jail rather than a hospital. Ouch. And wasn't it Blue Cross that got caught throwing claims in the trash can years ago? Naw, that couldn't have been them. They are heroes of the ACA. Staunch Democrats. Obamacare all the way. Except...
Before BCBC loved the ACA the were trying to kill it. With ALEC of all groups. Icky.
http://thinkprogress.org/...
You know, I am not really sure that the words "for profit" and "health care" go together. Of course, some of the Blues are "non-profit"...or are they?
http://www.prwatch.org/...
According to a report by Carl McDonald of Citi Investment Research and Analysis, last year was the most profitable year in history for the Blues plans, which enjoy significant tax advantages because of their claim to be nonprofit and terrific community citizens. Collectively, the Blues reported more than $5.5 billion in net income in 2010.
Not only that, but the Blues now have more than five times that amount in capital above what state regulators require. As McDonald noted in his report, maintaining such a huge reserve should make regulators think twice before approving rate increases in the future.
You know, I hope that the Blues got over their ALEC loving ways. I would hate to think that a company that was not 100% in favor of the ACA is playing such a big part in the roll out of our nation's most important health care legislation since Medicare. In particular, I would not want any voters to get the idea that their individual problems with their individual ACA insurance company has anything to do with the Act itself.