Two Cobb County residents filed a lawsuit Tuesday against Anthem Blue Cross and Blue Shield, saying the insurer misled Georgia consumers into believing WellStar Health System was in its exchange network when they signed up for coverage.<\/p>\n\n\n\n
The lawsuit, filed in federal court in Atlanta, is the latest chapter in the dispute over the exchange contract between Anthem and WellStar.<\/p>\n\n\n\n
The contract was terminated Monday, affecting thousands of Georgians who have exchange coverage. Anthem Blue Cross said Monday that it would allow another 90 days of network coverage for those members who selected, were assigned or tried to choose a WellStar-affiliated primary care physician.<\/p>\n\n\n\n
But that extension did not appear to mollify either WellStar or the plaintiffs.<\/p>\n\n\n\n
The lawsuit alleges that Anthem had notified WellStar in August 2018 that it would be ending the exchange contract with the Marietta-based health system. But despite that notification, Anthem did not inform potential customers looking for individual policies during Open Enrollment in November and December, the suit claims.<\/p>\n\n\n\n
Attorney Jason Doss of the Doss Law Firm in Atlanta<\/a>, who filed the suit, said the non-disclosure was a case of \u201ca bait-and-switch\u2019\u2019 based on false advertising. Doss said the suit is considered a class-action complaint, seeking to cover others similarly affected.<\/p>\n\n\n\n Anthem spokesman Colin Manning said Tuesday that the company does not comment on pending litigation.<\/p>\n\n\n\n One of the plaintiffs, Frances Kirby, 56, said she chose Anthem because her longtime primary care physician and several of her specialists were WellStar doctors and were listed as part of the Indianapolis-based insurer\u2019s network here. She said WellStar operates the only hospitals in Cobb County, where she lives.<\/p>\n\n\n\n Anthem \u201cmade uniform misrepresentations and omissions to consumers as well as its independent brokers during the enrollment process that WellStar would be an available provider to policyholders in Anthem\u2019s Pathway Health Plan,\u2019\u2019 the lawsuit says. It alleges that Anthem concealed the contract termination from consumers \u2018\u2019for the purpose of inducing them to select Anthem as their health care provider.\u2019\u2019<\/p>\n\n\n\n The dispute does not apply to WellStar patients who have employer-based or Medicare Advantage coverage.<\/p>\n\n\n\n The biggest area of impact of the contract termination is in Cobb County and other northwest Atlanta suburbs, where WellStar dominates the health care market.<\/p>\n\n\n\n Also on Tuesday, James Budzinski, WellStar\u2019s chief financial officer, told GHN that Anthem did not follow the designated protocols for ending the contract. He said the dispute will go through a mediation process in March.<\/p>\n\n\n\n \u201cBlue Cross is not consulting us at all regarding how they\u2019re going to handle the situation,\u2019\u2019 Budzinski told GHN.<\/p>\n\n\n\n WellStar said it\u2019s sending letters to the more than 1,000 patients with Anthem exchange insurance that received services during January, before the contract cutoff.<\/p>\n\n\n\n Budzinski said the Marietta-based health system didn\u2019t know which of its patients signed up for the exchange until those people sought medical care. \u201cOnly Anthem knew,\u2019\u2019 he said.<\/p>\n\n\n\n Anthem\u2019s 90-day extension of network coverage, Budzinski pointed out, does not apply to WellStar\u2019s specialist physicians nor its 11 hospitals.<\/p>\n\n\n\n Attorney Doss called the 90-day reprieve \u201ca temporary Band-Aid\u2019\u2019 and a \u201cnon-solution.\u201d<\/p>\n\n\n\n The lawsuit notes that the Open Enrollment for the exchange has ended, and that the plaintiffs are \u201clocked into\u2019\u2019 their current plan till next year.<\/p>\n\n\n\n The second plaintiff, John David Marks, 63, said Tuesday that he had to cancel an appointment with his urologist because that doctor is no longer in network.<\/p>\n\n\n\n \u201cI was diagnosed with prostate cancer a year and a half ago,\u2019\u2019 Marks told GHN. \u201cI\u2019m in a surveillance program.\u2019\u2019<\/p>\n\n\n\n He said he also has heart problems. He said that while a WellStar hospital is just 5 minutes away from his home, the closest non-WellStar hospital is 25 miles away.<\/p>\n\n\n\n Marks said he switched to Anthem in the exchange because there were more facilities available, the cost was cheaper, and WellStar providers were listed as part of the network.<\/p>\n\n\n\n \u201cI have established relationships with these doctors,\u2019\u2019 he said. When told that he would be out of network for the urology visit, Marks said that he replied, \u201cThere must be some mistake.\u2019\u2019<\/p>\n\n\n\n Marks said of Anthem, \u201cI want to hold these people accountable.\u2019\u2019<\/p>\n\n\n\n WellStar\u2019s Budzinski said that during the 90-day extension, WellStar patients will face the same out-of-pocket costs if Anthem pays the doctors at a network rate.<\/p>\n\n\n\n But if the insurer pays the doctor below those rates, WellStar will bill the patient for the difference, he said.<\/p>\n\n\n\n Anthem\u2019s Manning, though, said Tuesday that the insurer will pay the doctors at the regular contracted rate during the extension period.<\/p>\n\n\n\n The company is Georgia\u2019s largest health insurer.<\/p>\n\n\n\n In a statement Monday, the insurer acknowledged that some Georgia consumers \u201cmay have enrolled in Anthem plans based on the incorrect assumption WellStar would remain in our Pathway network throughout 2019.\u2019\u2019<\/p>\n\n\n\n Anthem said it has worked closely with Georgia Insurance Commissioner Jim Beck to extend WellStar coverage beyond Monday. The insurer said it is sending letters to affected policyholders.<\/p>\n\n\n\n \u201cWe look forward to ensuring our members receive high-quality, affordable care through our network of participating providers and hospitals,\u201d Anthem said. \u201cConsumers with questions can call the number on the back of their Anthem ID card or go to anthem.com\/wellstar.<\/a>\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Two Cobb County residents filed a lawsuit Tuesday against Anthem Blue Cross and Blue Shield, saying the insurer misled Georgia consumers into believing WellStar Health System was in its exchange network when they signed up for coverage. The lawsuit, filed in federal court in Atlanta, is the latest chapter in the dispute over the exchange […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"newspack_featured_image_position":"","newspack_post_subtitle":"","newspack_article_summary_title":"Overview:","newspack_article_summary":"","newspack_hide_updated_date":false,"newspack_show_updated_date":false,"footnotes":""},"categories":[58],"tags":[],"class_list":["post-7860","post","type-post","status-publish","format-standard","hentry","category-family","entry"],"_links":{"self":[{"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=\/wp\/v2\/posts\/7860","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7860"}],"version-history":[{"count":0,"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=\/wp\/v2\/posts\/7860\/revisions"}],"wp:attachment":[{"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7860"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7860"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thegeorgiasun.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7860"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}