Thousands of patients could have been forced to pay thousands more than necessary as a result of fraud allegedly committed by Anthem Blue Cross Blue Shield of New York, a new lawsuit claims.
Pollock Cohen LLP and Walden Macht Haran & Williams filed the class action lawsuit this week against the major insurer, accusing Anthem of publishing an inaccurate directory of doctors who were supposed to accept the insurance. Instead, the "ghost networks" caused patients to fork over substantial amounts of money out of pocket because they were out of network.
"Naturally, if you see a list of professionals and the services they offer issued by a provider, you would expect those to be covered by their insurance plans," Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek.
"The allegation is the list provided made many of their clients seek help from entities on the list that ended up not being covered, which not just led to additional expenses, but also to stress on the physical and mental health of those who did so."
The lawsuit was filed in federal court in the Southern District of New York. Affected patients could have lost thousands of dollars if they were unaware that their provider didn't actually accept their insurance.
Newsweek reached out to Anthem and the plaintiffs' attorneys by email for comment.
Because of the confusion, many patients also faced significant delays in finding health care or gave up entirely, according to the lawsuit.
"The Defendant's publication of an inaccurate provider directory is not just an inconvenience for people searching for mental health providers; it is far more insidious and costly," the complaint reads.
"By publishing an inaccurate provider directory where the vast majority of doctors listed – more than 80% – either don't exist, are listed with non-working telephone numbers, or are listed with inaccurate telephone numbers – making them virtually impossible to contact – or are not actually in-network with Defendant, the Defendant did not just mislead people, but damaged them."
Plaintiffs looking for mental health services said they called dozens of doctors listed in the BCBS directory who did not actually accept their insurance.
"These ghost networks are also replete with errors and duplications, which make them inaccurate, incomplete, deceptive, and misleading," the lawsuit says. "Mental health provider directories are more likely than those in any other medical specialty to be ghost networks."
A study by attorneys found that only seven out of 100 listed doctors actually accepted Anthem and would take new patients.
"We knew ghost networks were a problem, but we had no idea it was this bad," lead attorney Steve Cohen of Pollock Cohen said in a statement. "Both the New York State Attorney General and the United States Senate have conducted similar secret shopper studies. But neither investigation was as extensive as the one we conducted on behalf of these plaintiffs. And the findings were just shocking—it is nearly impossible to find doctors who accept this insurance."
That caused people in need of medical care to be "intentionally" misled by Anthem, said Jacob Gardener, a partner at Walden Macht Haran & Williams.
"It costs these patients not just money but precious time to find necessary care," Gardener said in a statement. "And that is for the lucky ones: just imagine the anguish parents must go through when they cannot find affordable, qualified care for their children."
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