Woman Sues California Blue Shield For Alleged Safety-Net Insurance OverchargesLos Angeles Times: A Los Angeles woman is suing Blue Shield of California for allegedly overcharging policyholders for safety-net insurance for the jobless or sick. "Amalia Lample said in her lawsuit that Blue Shield, the state's second-largest not-for-profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines. Lample, 64, argued that she is owed $4,475 in excess charges she paid from 2007 to 2009. She said that more than 6,000 Blue Shield policyholders with similar coverage also were overcharged since 2001. ... Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law."
A spokeswoman for the California Department of Managed Health Care said the law's definition "for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much." The coverage at issue is that which is available under HIPAA. "Insurers are required by the federal law to sell insurance to people who have lost their jobs or who would otherwise be ineligible because of preexisting medical conditions. HIPAA policyholders maintain that Blue Shield and one of its chief competitors, Anthem Blue Cross, have substantially overcharged subscribers for several years." Anthem has since decided it overcharged for the coverage between 2006 and 2009 and agreed to refunds (Helfand, 7/8). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.