Anthem Blue Cross Under Investigation

Anthem Blue Cross is a well-known, major play player in the insurance marketplace. However, the insurance giant is under investigation by the California Department of Managed Health Care. Covered California is looking into the accuracy of Anthem Blue Cross’ provider networks due to a series of complaints by policy holders. This investigation initiated from multiple law suits brought on against Anthem by the consumers including one last June by WellPoint, Inc.

What are policy holders upset about?

  • Narrow provider networks
  • Loss of benefits
  • Bait and switch tactics to get consumers with expiring plans to enroll in different coverage where former benefits may no longer be provided without the consumer’s knowledge

Many California policy holders are stating that Anthem Blue Cross has extremely narrow provider networks making it difficult for them to seek medical attention covered under their current plan. People who purchased Anthem plans under the Covered California health exchange thought they had more options, which is why the California Department of Manager Health Care is investigating whether Anthem may have inflated the number of providers in an effort to increase enrollment participants. Anthem is saying that in order to reduce premiums, they had to decrease the number of doctors and hospitals available to patients.

According to the LA Times, one policy holder who had an Anthem plan no longer compliant with the Affordable Care Act was forced to switch to a different policy that Anthem assured her would cover the same benefits as her previous plan. However, the exclusive provider network they were claiming to enroll her in ended up being a PPO that did not cover her expenses leading to to rack up thousands of dollars in medical bills. Anthem Blue Cross refuses to pay the bills.

As a result, the executive director of Covered California, Peter Lee, is looking into these EPO policies for 2015 since they seem to have caused many consumer frustrations and large, unknown medical bills. An exchange spokeswoman stated that EPOs will still be part of the exchange benefits but they are looking into ways to better educate people about how the networks and coverage work.

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