Pasadena, CAAnthem Blue Cross is on the receiving end of an insurance lawsuit, alleging the company acted in bad faith and breached its contract with policyholders. Many lawsuits have been filed against insurance companies, alleging the companies breached the covenant of good faith and fair dealing. This lawsuit claims Anthem Blue Cross unfairly denied coverage that policyholders were misled into believing they had.
According to court documents, the lawsuit (case number BC 549438, filed in Superior Court for the State of California, County of Los Angeles) was filed by Samantha Berryessa Cowart. Cowart filed the lawsuit
“to stop Anthem Blue Cross from unlawfully misleading its members regarding their coverage and which providers are in their network.”
The lawsuit claims that Anthem Blue Cross issued member identification cards that led members to believe they were enrolled in the Preferred Provider Organization plans when they were actually in the Exclusive Provider Organization plans. The difference is that the Preferred Provider plans gave members access to a wide network of Anthem providers. Preferred Provider members also had the ability to get covered treatment from out-of-network providers.
Exclusive Provider members had access to limited providers and no coverage if they accessed out-of-network treatment providers. Because the cards reportedly stated the members were Preferred Provider policyholders, they believed they had access to a wide network of treatment providers. According to the lawsuit, members who received those cards underwent treatment thinking the costs would be covered, only to have that coverage denied.
Cowart alleges Anthem changed her policy without telling her about the change in coverage or the change in plans. Furthermore, her new Anthem card still contained a logo with the letters PPO (for Preferred Provider Organization) on it. When Cowart required medical care, her insurance card was accepted and treatment was provided but Anthem refused coverage because the doctor was out-of-network. Furthermore, when Cowart tried to find doctors within her network, Anthem allegedly “failed to provide accurate information about its network providers,” preventing Cowart from receiving timely medical treatment.
The lawsuit seeks to represent all California residents who are members of any Anthem Exclusive Provider plan but who received a Preferred Provider plan card.
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