The backlash against narrow networks continues, as more displeased individual health consumers take their grievances to the courts of law and public opinion.
Two class action lawsuits have been filed against Blue Shield of California and Cigna, alleging that provider networks for their exchange plans were misrepresented and changed arbitrarily, with consumers buying plans on the reassurance that they could keep long-time physicians, only to find them out-of-network a few months later.
Whether or not the network problems were actually intentional, the group behind the lawsuits, Consumer Watchdog, believes the insurers were using a "bait and switch" tactic to drive sales.
In a class action brought by attorneys for Consumer Watchdog and Shernoff Bidart Echeverria Bentley, an Orange County resident named Sheila Davidson claims she experienced delays and interruptions in her treatment for pelvic inflammatory disease and peritonitis after buying an off-exchange Cigna plan.
The "single most important factor was to be able to continue care with the same team of physicians that have been treating my serious medical conditions for years," Davidson said in a statement. "I did a lot of research before purchasing my plan and confirmed on Cigna's website that all of my doctors were listed as in-network."
Initially, her treatments were covered, but then her providers became out-of-network, along with the bills, in what amounts to a violation of California's "continuity of care" protections, the lawsuit contends.
The dispute with Cigna concerns plans sold outside of the state exchange, Covered California. The company withdrew from Covered California before open enrollment last year, but still sold individual plans in the state with the same benefits and actuarial value as exchange plans, via private channels like eHealth Insurance -- while coming under some regulatory fire for initially including the name Covered California in the titles of some of the plans, even though they weren't sold on the exchange
Davidson and her attorneys are asking the Superior Court of California in Los Angeles to order Cigna to amend their policies, cover the outstanding bills and pay back all premiums -- to her and all Californians who bought individual plans from the company since October of last year.
For Blue Shield of California, this is not the first lawsuit over new individual plans. In May, two San Francisco residents sued the insurer alleging that its exchange PPO plans were deceitfully marketed.
Now, Consumer Watchdog and Shernoff Bidart attorneys are representing four residents who say they bought EPO and PPO plans whose provider networks were misrepresented and, on second look, inadequate.
After selecting Blue Shield plans and paying for them, the plaintiffs claim they found that promised providers were not in-network and advertised fee schedules and cost-sharing were not available.
"Blue Shield concealed its reduced networks during the open enrollment period in order to increase sales of its health service plans," the attorneys wrote. "Plaintiffs and Class Members did not find out about the reduced networks until after the open enrollment period ended and they had purchased their plans, thus locking Plaintiffs and Class Members into the misrepresented plans until the next open enrollment period."
In this case, the plaintiffs are trying to recover unspecified damages from Blue Shield for them and all affected consumers, along with a court order to reform the alleged practices and restitution for premiums paid.
Neither Blue Shield nor Cigna has yet responded to the lawsuits.