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Proposed Health Insurance Consumer Class Denied TRO to Stop Anthem’s Alleged Plan-Switching

MedicalBy William M. Strom

On November 15, plaintiffs lost their TRO motion in a proposed consumer class action alleging that Anthem Blue Cross of California made unannounced benefits cuts for renewing health insurance customers who purchased from Anthem or from the state’s health insurance exchange, Covered California.  Plaintiffs contend that Anthem is switching health insurance customers without warning from Preferred Provider Organizations (PPOs), which cover some out-of-network services, to Exclusive Provider Organizations (EPOs), which offer no out-of-network coverage, in violation of the federal Affordable Care Act (ACA) and California state consumer protection law.  Plaintiffs cite notices Anthem sent to many of its California customers earlier this year assuring customers that their plans would be renewed if they took no action.  In truth, plaintiffs allege, Anthem will switch these customers from PPOs to EPOs.  As a result of these switches, say plaintiffs, some health insurance customers will lose access their physicians.  Plaintiffs seek a court order requiring Anthem to keep customers’ existing health insurance plans in place.

Judge John Shepard Wily, Jr., of the Superior Court of California, Los Angeles County, denied plaintiffs’ motion for TRO on the ground that plaintiffs had yet to suffer injury due to the health-plan changes, which are not scheduled to take effect until January. Plaintiffs have not filed a notice of appeal to date.  Anthem spokesperson Darrel Ng said that the company was pleased with the court’s decision and that state regulators have approved Anthem’s policy changes.

The case is Simon v. Blue Cross of California, Superior Court of California, Los Angeles County, No. BC639205. Click here to read the L.A. Times’ report on the case.