'Bait & Switch' Suit Alleges Health Insurers Mislead Consumers

Two of America’s biggest health insurance companies allegedly misrepresented their physician and hospital networks in order to boost sales during the Affordable Care Act’s “open enrollment period”, a consumer advocacy group said Thursday.

KNX 1070’s Jon Baird reports attorneys for Santa Monica-based Consumer Watchdog filed two separate lawsuits in Los Angeles County Superior Court against Cigna and Blue Shield of California in what the group calls a “bait and switch” scheme that left patients with a stack of medical bills and no coverage.

The class action lawsuit against Cigna targets Cigna’s misrepresentations of its “provider” networks of physicians and hospitals, which allegedly caused delays and interruptions in accessing needed health care following the open enrollment period that ended on March 31, according to attorneys.

Cigna sold its plans as “Covered California” health exchange plans even though Cigna’s plans were not sold through the state exchange and the California Attorney General advised them not to label their plans as such, said Laura Antonini, staff attorney for Consumer Watchdog.

In addition to Blue Shield’s alleged misrepresentations of its provider networks, the new lawsuit filed by attorneys also alleges that Blue Shield violated California laws by failing to provide any proof of insurance for two to three months and subjecting consumers to exceedingly long wait times – often as long as several hours – on customer service telephone lines when consumers called to address these problems and misrepresentations.

“Consumers with health insurance are left with these huge bills after they go to the hospital,” said Consumer Watchdog’s Jerry Flanagan.

Sheila Davidson is among those alleged victims who says she thought she was covered through Cigna until she began receiving demands for payment.

“As I approached reaching my out-of-pocket [limit], all of a sudden the coverage for all of my treatment and all of my doctors was pulled out from under me,” said Davidson.

Blue Shield spokesman Sean Barry issued the following statement: “Blue Shield has received a class action lawsuit filed on September 23, 2014 against the company in Superior Court in the County of Los Angeles. We will review the complaint and may have more to say at a later time.”

A spokesperson for Cigna declined to comment on the lawsuits.