Denial of Reimbursement or Delayed Reimbursement
The Advocate Health Care Network has a Disability Income Protection Plan that provides funds for employees who have a long- or short-term disability and are unable to work because of sickness or injury. The plan coordinates its own benefits with benefits paid by other parties, such as Social Security. However, complaint for this class action alleges that the Plan refuses to recognize the common fund doctrine, which allows participants to recover any legal or other expenses they incur in obtaining those benefits.
Under California law, insurers must pay reasonable fees to medical providers for emergency services performed on one of their insureds, even if the medical providers are not part of their own networks. California laws also require prompt payment to medical providers. The complaint for this class action claims that Anthem Blue Cross complies with neither of these laws.