Lawsuits Allege Insurance Companies Misrepresented Coverage - NBC Southern California
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Lawsuits Allege Insurance Companies Misrepresented Coverage

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    A class action lawsuit against medical insurance providers Blue Shield and Cigna alleges that in trying to sell their policies to customers, they misled them about doctors and hospitals that weren't always in their networks. NBC4 I-Team consumer reporter Randy Mac reports for the NBC4 News at 6 p.m. on Thursday, Sept. 25, 2014. (Published Thursday, Sept. 25, 2014)

    As Sheila Davidson recovers from surgical complications, she said it's her Cigna healthcare policy that's making her sick.

    "It's a nightmare," Davidson said. "I fought this hard to get my health back. I'm not letting it go yet."

    Sally Greer suffers from heart disease, but calls her policy with Blue Shield "heartless."

    "I don't know what to do," Greer said. "There's nowhere to turn because they're offering no options."

    The women are plaintiffs in two separate class action lawsuits filed by Consumer Watchdog against Blue Shield and Cigna of California.

    "In order to boost profits and market share, Cigna and Blue Shield have pulled off a blatant bait-and-switch," said Consumer Watchdog attorney Jerry Flanagan.

    The lawsuits allege that during enrollment under the Affordable Care Act, Blue Shield and Cigna both advertised dozens of doctors and hospitals as being in their networks to get customers to buy their policies.

    "As I approached reaching my out-of-pocket, all of a sudden the coverage for all of my treatment and all my doctors was pulled out from under me," Davidson said.

    According to Consumer Watchdog, the lawsuits allege:

    • "Patients' doctors and hospitals are not in-network, resulting in interruptions of care;
    • "Negotiated fee schedules are not available, resulting in increased out of pocket costs;
    • "Payments made to out-of-network doctors and hospitals do not accrue toward annual deductible and out-of-pocket limits causing consumers to face huge unpaid medical bills when they get sick;
    • "Consumers did not fully learn of the misrepresentations until after the open enrollment period ended on March 31. Therefore, consumers are stuck with their inadequate coverage and unexpected medical bills until they can switch plans during the next open enrollment period."

    Greer said she racked up thousands of dollars in medical debts after learning her doctors were not in her policy's network, but were listed on Blue Shield's website at the time she purchased coverage.

    "I said, 'What do I do with the bill from UCI?'" Greer said. "And they said, 'Well, tough luck. You'll pay for it.'"

    Blue Shield issued a statement that read in full: "Blue Shield has received a class action lawsuit filed on September 23, 2014 against the company in Superior Court in the County of Los Angeles. We will review the complaint and may have more to say at a later time."

    Cigna declined to comment to NBC4 citing the pending litigation.