WellStar is “Georgia’s largest health care provider,” says the complaint for this class action. That’s why the complaint alleges that various Anthem companies were deceitful in giving the impression that WellStar would be an in-network provider for the coming year for its Pathway Health Plan.
The class for this action is all Georgia residents who bought an individual Pathway health insurance plan from any of the defendants, between November 1 and December 15, 2018.
The defendants in this case, Anthem, Inc., Blue Cross and Blue Shield of Georgia, Inc., and Anthem Insurance Companies (collectively, “Anthem”), offer yearly health care insurance coverage. The most recent open enrollment period ran from November 1 to December 15, 2018.
During that time, the complaint alleges, the Anthem companies gave consumers the impression that if they if they bought Anthem’s Pathway Health Plan, WellStar would be an in-network provider.
If WellStar is, as the complaint claims, “virtually the exclusive health care provider in northwest metro-Atlanta[,]”that would be an important point for many consumers.
The complaint claims that “as part of the application process, Plaintiffs … were required by Anthem’s uniform intake process to select primary care physicians, which included WellStar doctors.” Anthem even issued insurance cards to the applicants bearing the names of these doctors.
However, the complaint says that, during the open enrollment period, “Anthem had already notified WellStar … that it would not be providing coverage for WellStar’s services” during the term covered by the policies it was selling.
One of the plaintiffs in this case, Frances Kirby, enrolled with Anthem for 2019, even though she’d been with a different insurer in 2018. Kirby has been seeing the same doctor for over twenty years. She also has health issues that require nine different specialists. A majority of those specialists are WellStar doctors. When Kirby signed up for the Anthem plan, it was important to her that her doctors were all in-network. Her plan has no coverage at all for out-of-network providers.
Only when she went to see her doctor in January 2019 did she find out that he would not be a covered provider as of February 4. She had not received any notice from Anthem about this, and her doctor was still listed on Anthem’s website as a covered provider. She will now likely have an interruption in care, the complaint says, as she must choose all new providers, including most of her specialists. As a new patient with these providers, she is likely to have to undergo new tests and otherwise catch them up on her condition and care.
The complaint claims breach of contract, breach of the covenant of good faith and fair dealing, and fraudulent concealment, among other things.