After months of mediation, a lawsuit filed by WellStar Health Systems against Blue Cross Blue Shield Healthcare Plan of Georgia, known as Anthem Blue, is still pending, according to the Cobb Business Journal.
WellStar filed a lawsuit in late May claiming that Anthem Blue made false representations to customers by advertising on its website and in written materials that WellStar would be participating in the Pathways Network, which Anthem Blue sells on the ACA marketplace.
Last August, Anthem Blue notified WellStar that beginning in February 2019 it would discontinue WellStar as a provider for its Pathways plan, the Cobb Business Journal reports. WellStar contends that various customers were able to sign up for the Pathways plan during open enrollment because Anthem Blue advertised WellStar would be in network.
“Based on Blue Cross’ intentionally deceptive representations that WellStar would be ‘in network,’ consumers chose the Pathways Network over other plans that actually did include WellStar as ‘in network,'” the lawsuit says. “Consumers have expressed that they were shocked to learn that Blue Cross had excluded WellStar from the Pathways Network and only learned of such purported termination when they tried to schedule appointments for ‘in network’ services at WellStar.”
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Anthem Blue is seeking to dismiss the lawsuit. The insurer says it acted in good faith and followed all applicable laws and regulations.
In June, the Georgia Department of Insurance and Anthem Blue reached an agreement that the health insurer would extend benefits to affected Pathways members. The extended benefits allow customers to receive treatment from WellStar primary care physicians and specialists through Dec. 31, reports the Cobb Business Journal.
WellStar claims that it suffered “irreparable damage” to its “reputation and goodwill,” because of the alleged false marketing. The company is seeking “all attorneys’ feels and litigation expenses that WellStar has incurred, and will continue to incur because of Blue Cross’ conduct,” court documents indicate.
Date: August 13, 2019
Source: Becker’s Hospital Review