ObamaCare Clustefuck: Be sure to record any conversations you have with your insurance company
In their complaint filed in California state court on Wednesday, San Francisco residents John Harrington and Alex Talon accused Blue Shield of misrepresenting that their plans, sold on California's health exchange, would cover the full provider network advertised on the company's website.
They sued on behalf of a class of people who had purchased so-called "preferred provider organization" plans from the insurer only to realize that the doctor and hospital networks for their plans were limited.
Harrington bought a so-called silver plan on California's online exchange while Talon bought a platinum plan through the insurer's website. They said they made their choices based on Blue Shield's alleged representations that their doctors would be covered.
After receiving medical treatment numerous times between January and March, Harrington and Talon later discovered that their providers were not covered, forcing them to pay the charges out-of-pocket, the complaint said.
So, it's not just the narrow networks, it's that the insurers conceal how narrow the networks really are.
David Cienfuegos said his wife was told by Anthem Blue Cross that his doctor was part of the insurer's coverage network, but then was left with the tab for about $5,800 in medical costs after Anthem insisted that it never said any such thing.
In this case, though, Cienfuegos, 40, has a digital recording of the Anthem rep clearly saying his surgery would be covered.
And he's suing to hold the insurer accountable.
In its Feb. 19 letter rejecting Cienfuegos' appeal, Anthem said the company's own records show that "no specific provider was mentioned in the conversation nor was it noted you were misinformed about participating status for this specific provider in question."
That's just b-i-z-a-r-r-e.
Cienfuegos' wife can be heard on the recording spelling out the provider's name, and the Anthem rep can be heard confirming both his in-network status and that the procedure would be covered.
And then they try to deny coverage anyhow!
NOTE Hat tip, Hipparchia.