Anthem Blue Cross: Does It Really Want To Fix What’s Broken?

Article: Anthem Blue Cross: Does It Really Want To Fix What’s Broken?

Advertisements by Anthem Blue Cross, California’s largest for profit insurer, promise to “fix what’s broken without breaking what already works.” However, consumer advocates wonder whether the company really means what it says.

Damage control or real change?

In addition to wanting to fix what’s broken, other recent advertisements say that Blue Cross is “committed to helping improve the health of our members throughout the state and the quality and affordability of the care delivered to them." However, consumer advocates point out that the insurer has been fined and sued for doing just the opposite over the past two years. Recent fines and lawsuits include:

2008: Los Angeles City Attorney, Rocky Delgadillo, filed suit against Blue Cross for illegal business practices, misleading advertising and illegal insurance policy rescissions. The lawsuit alleges that Blue Cross:

Used false and misleading advertising to attract more than 500,000 customers
Employed and used untrained and unsupervised agents in completing customer applications – which further complicated the process
Collected applications from customers using intentionally misleading forms with little or no meaningful review of the accuracy of responses or informed investigation into the medical history of applicants and would then retroactively review applications in order to find discrepancies.

Delgadillo said that the lawsuit is on behalf of 6,000 individuals whose benefits have been denied since 2002 and thousands of others whose benefits have been delayed due to Blue Cross’s practices. The potential fines could add up to $1 billion.

2007: California’s Department of Managed Health Care (DMHC) fined Blue Cross of California $1 million for illegally rescinding health insurance policies and for not conforming to state law. After reviewing insurer documents, the DMHC found that Blue Cross did not prove that policyholders willfully misrepresented their medical histories before coverage was rescinded and did not conduct a thorough and complete pre-enrollment investigation of applicants’ medical histories (or even to its own underwriting policies) before issuing coverage.

So, are their advertisements touting customer commitment a sign of real change or merely damage control to downplay bad publicity? Only time will tell, but consumers who have wrongfully been denied valid insurance benefits don’t have to wait and see. If your insurance company has acted in bad faith, contact an attorney whose practice focuses in this area of the law to discuss your situation. Consultations are free, without obligation and strictly confidential. To contact a qualified attorney, please click here.