Anthem, Blue Cross Blue Shield of GA Hit with Class Action After Allegedly Claiming WellStar was In-Network Provider

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Two consumers have filed a proposed class action lawsuit against Anthem, Blue Cross and Blue Shield of Georgia, and Anthem Insurance Companies, over what the plaintiffs claim are “material misrepresentations and omissions” made by Anthem with regard to the scope of its health insurance coverage. The 39-page case alleges Anthem misled Georgia consumers into purchasing individual and family Pathway Health Plan policies for which they believed the state’s largest healthcare provider, WellStar Health System, was an in-network provider. Anthem, the lawsuit claims, sold consumers such policies despite knowing the opposite was true.

The case states that Anthem is the only health insurance provider for 44 mostly rural Georgia counties, effectively evidencing the importance to consumers of having access to the WellStar network. During the most recent enrollment period, November 1, 2018, to December 15, 2018, the lawsuit says, Anthem uniformly claimed that WellStar would be in-network for its Pathway Health Plan. According to the suit, however, Anthem, as far back as August 2018, had already notified WellStar that it would not be covering the company’s services for 2019, a fact allegedly concealed from consumers “for the purpose of inducing them to select Anthem as their healthcare provider.”

The complaint points first and foremost to Anthem’s website, which allegedly contained a number of inaccuracies with regard to the supposedly in-network providers and primary care doctors under its Pathway Health Plan. From the case:

“Anthem tells prospective policyholders to use the provider finder tool on its website, www.anthem.com, to determine which physicians and providers are in-network for Anthem’s health insurance plans. Anthem’s provider finder tool, however, has many inaccuracies and many of the providers listed do not accept Anthem’s Pathway Health Plan. In addition, as part of the application process, Plaintiffs and others similarly situated were required by Anthem’s uniform intake process to select primary care physicians, which included WellStar doctors. Anthem then issued health insurance cards to Plaintiffs identifying the WellStar primary care physician by name, all the while knowing that Anthem did not intend to include them as an in-network provider.” 

What consumers are left with, the plaintiffs charge, are already paid-up health insurance premiums that have locked them in with Anthem until the next open enrollment period in November 2019. At the end of the day, proposed class members from under whom Anthem “pulled the rug out,” the lawsuit says, must pay the full price for medical treatments, “as if they did not have any health insurance at all.” 

The full lawsuit can be read below.