Consumer Group Sues 2 More Calif. Plans Over Narrow Networks


This KHN story can be republished for free. (details)

Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles.

“As a result, many patients were left without coverage in the course of treatment,” said Laura Antonini, staff attorney for Consumer Watchdog, a Santa Monica-based advocacy group that filed the case.

Both cases allege that the insurers offered inadequate networks of doctors and hospitals  and that the companies advertised lists of participating providers that were incorrect.  Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status.

Cigna and Blue Shield officials said they had not seen the complaints and declined to comment.

In July, Consumer Watchdog filed a lawsuit against insurance giant Anthem Blue Cross of California with similar allegations. No court date has been set.

The cases are part of growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the state and federal insurance marketplaces created by the Affordable Care Act.  Insurers say such plans are necessary to hold down premium prices. Consumer Watchdog is also putting a measure on the November ballot that would give the state insurance commissioner greater authority to veto rate increases.

The new lawsuits relate to Blue Shield plans sold through the state-run Covered California website, and Cigna plans sold outside of that marketplace.

According to the Cigna complaint, Sheila Davidson, a 61-year-old from Orange County suffering from pelvic inflammatory disease and other health problems, selected a plan after her former policy was cancelled, and after checking to make sure her specialists were included.  At first, the plan paid her doctors’ bills and counted her share of the payments toward her annual deductible.

But the complaint alleges that when Davidson was about to reach the $6,350 annual maximum she had to pay for in-network care, Cigna switched all her doctors to out-of-network status.  That meant she had to pay a $12,500 deductible before the insurer reimbursed anything.  She has appealed that decision with the insurer, but has not yet received a decision, she said.

“Now I am left with thousands of dollars in medical bills and I am scared to continue treatment with my doctors or use my Cigna plan,” Davidson said in a statement released by Consumer Watchdog.

In the Blue Shield case, plaintiffs Kevin and Jane McCarthy of Ventura County say they checked that their doctors were participating in the plan before signing up. But after Kevin McCarthy saw his doctor and had some tests, he received a notice that the doctor was not in network. The McCarthys had to pay for the care and it did not count toward their annual deductible or out-of-pocket limit, the complaint says.  In addition, it alleges the nearest in-network doctor listed on the insurer’s website was 30 miles away in another county.

Blue Shield of California Foundation helps support KHN coverage of California.

Categories: Uncategorized