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East County News Service
November 10, 2015 (San Diego’s East County) – Two major insurance companies have been fined $650,000 by California for providing inaccurate information in doctor directories. In addition, class action lawsuits have been filed on behalf of patients overcharged as a result of those errors.
The Sacramento Bee reports that errors were found in over 25% of online doctor listings provided by Anthem Blue Cross and Blue Shield of California, ranging from errors in addressees to doctors listed who were not covered by the plans. That led to some patients being charged hefty out-of-network fees for medical visits they believed were covered.
The problems affected both patients in Covered California and those covered by private insurers.
The fines are minimal compared $38 million in refunds that Blue Shield has paid out to patients and now Anthem is also expected to pay out reimbursements as part of a pending class action lawsuit settlement.
A new bill, SB 137, has also been signed into law by Governor Brown. Once it takes effect in July, it will require all insurance companies in California to update online directories weekly and printed directories quarterly; doctors must verify any changes to their listings and can be fined if they fail to do so.
If you believe you are entitled to reimbursement for paying out-of-network fees due to an error in your insurer’s directory, call your insurance company using the number on the back of your member card. If you do not receive satisfaction, you can file a complaint with the Department of Managed Health Care at HealthHelp.ca.gov or call 888-466-2219.
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