A judge has given the nod to allow the insurer to move forward with a plan offering no out of network care coverage.
Anthem health insurance has been allowed to continue selling a California health plan that doesn’t offer out of network care coverage. A judge gave the ruling that stopped Anthem Blue Cross from being restrained from switching half a million Californians to the plan.
A consumer group requested that the judge keep a restraining order in place to stop Anthem from making the switches.
The restraint would have stopped the Anthem health insurance company from issuing certain notices to its customers. The notices stated that customers would be switched automatically from their current plans to the new one. This would mean that consumers would suddenly lose coverage for health care provided via out of network doctors and hospitals. The customers were to be given up to December 15 to either keep that plan or switch to one offering coverage outside the network.
Consumer Watchdog filed the lawsuit against Anthem health insurance in Los Angeles County Superior Court.
The consumer group, based in Santa Monica, California, argued that Anthem’s actions were illegal. The reasoning was that the health insurance company had not provided customers with clear information regarding the termination of their current coverage in a PPO (preferred provider organization).
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Anthem chose to alter the policies so they would become EPOs (exclusive provider organizations) in a large portion of California by next year. The only time those health plans provide coverage for out of network care is in the case of an emergency.
The altered health plans include those purchased by consumers who bought their Anthem health plans from Covered California.
Judge John Shepard Wiley Jr. explained that Consumer Watchdog offered inadequate standing in court to maintain a restraining order. This was because the plaintiffs had not experienced losses on the policies which will not become effective until January 1, 2017. Consumer Watchdog lawyer Jerry Flanagan explained that the entire purpose of the restraining order was to stop customers from experiencing those losses in the first place. A statement released by Anthem said the insurer feels the lawsuit did not have any merit.