Los Angeles, CAAnthem Blue Cross has agreed to pay $8.3 million to settle insurance lawsuits that alleged the company breached its contracts and engaged in unfair business practices. The settlement affects up to 50,000 Anthem Blue Cross customers who live in California and were affected by the company changing costs associated with individual policies. In agreeing to the settlement, Anthem Blue Cross did not admit liability.
According to the Los Angeles Times (10/27/15), two lawsuits were filed against Anthem Blue Cross, claiming the company illegally increased annual deductibles and other yearly costs mid-year. One of the plaintiffs in the case, Dave Jacobson, said his out-of-pocket maximum increased by $850 and his deductible increased by $25 partway through the year.
The insurer will mail notices to customers who were affected by the mid-year changes. Anthem has also reportedly agreed not to make cost increases midway through the year in the future. As many as 50,000 policyholders could be affected by the settlement.
Meanwhile, Anthem Blue Cross also faces a lawsuit alleging the company denied a policyholder necessary treatment because the insurer does not believe she is sick enough to require treatment. The lawsuit was reportedly filed by Marina Sheynberg, who alleged in her lawsuit that Anthem denied her medically necessary Harvoni treatment to treat her hepatitis C.
Hepatitis C is a contagious disease that can cause liver damage, infections and other serious health problems. Harvoni has been shown to be up to 95 percent effective in curing hepatitis C and reportedly causes few side effects. It is, however, an expensive medication with a 12-week course costing $99,000. As a result, some insurers have denied Harvoni treatment on the grounds that the patient’s liver is not sufficiently injured enough to justify treatment.
Lawsuits have been filed against insurers alleging they have repeatedly refused Harvoni treatment, despite having received information from doctors that the treatment was necessary for the patient. At least two other lawsuits have been filed against Blue Cross claiming the insurer is forcing patients to undergo significant damage to their liver before approving treatment.
The lawsuit is Sheynberg v. Anthem Blue Cross Life and Health Insurance Co., Case No. 3:15-cv-03417, in the US District Court for the Northern District of California.
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