Nearly two months after an agreement to extend benefits to cover some WellStar Health Systems services, a lawsuit filed against Blue Cross Blue Shield Healthcare Plan of Georgia by the Cobb-based company remains pending.
In its suit filed in late May in Cobb Superior Court, WellStar contends that Blue Cross Blue Shield Healthcare Plan of Georgia, also known as Anthem Blue, made false representations to customers by claiming on its website and in other written materials that WellStar would be participating in the Pathways Network, which Anthem sells on the Affordable Care Act marketplace, according to court documents.
“Based on Blue Cross’ intentionally deceptive representations that WellStar would be ‘in network,’ consumers chose the Pathways Network over other plans that actually did include WellStar as ‘in network,’” the suit contends. “... consumers have expressed that they were shocked to learn that Blue Cross had excluded WellStar from the Pathways Network and only learned of such purported termination when they tried to schedule appointments for ‘in network’ services at WellStar. Because of these intentionally false and deceptive practices, Blue Cross secured additional enrollees at WellStar’s expense.”
WellStar, the suit claims, suffered “irreparable damage” to its “reputation and goodwill,” along with damages as a direct result of Blue Cross. The suit seeks “all attorneys’ fees and litigation expenses that WellStar has incurred, and will continue to incur because of Blue Cross’ conduct,” and any additional judgments granted by a jury.
According to its responses filed in mid-July, Anthem is seeking to dismiss the lawsuit, denying WellStar’s claims and contending that it had acted in good faith and followed all applicable laws and regulations. It is also seeking attorneys’ fees and any further relief granted by the court.
The suit is currently in Cobb Superior Court. As of Monday, no court hearings had been scheduled.
“Anthem/Blue Cross Blue Shield notified WellStar in August 2018 that they were terminating WellStar as a participating provider in their Pathway products ... WellStar immediately disputed Anthem’s right to terminate WellStar from the Pathway products and continues to dispute this today. Unfortunately to date, mediation has not been successful and the parties have exhausted the dispute resolution provisions under our contract,” said Sophia Marshall, a WellStar spokesperson. “As such, while WellStar did file a complaint in court on May 30, 2019 regarding this dispute, WellStar recognizes that the resolution of this complaint is likely to be well after the fall 2019 Health Insurance Exchange open enrollment period for calendar 2020 health insurance coverage.”
Because of the dispute, Marshall added, “WellStar will continue working with our patients and Anthem to seamlessly restore access to our physicians, consistent with the consent order from the Department of Insurance, while continuing to dispute Anthem’s right to terminate our hospitals from the Pathway network under our contract with Anthem.”
The lawsuit is the latest episode in the conflict between WellStar and Anthem.
Last August, Anthem notified WellStar that in early February 2019, it would be dropping WellStar as a provider for its Pathways plan, which Anthem sells on the Affordable Care Act marketplace, according to court documents.
However, a class action suit filed in February alleged several people who signed up for the Pathways plan during open enrollment late last year did so because Anthem advertised that WellStar would be considered in-network.
In June, an agreement made between the Georgia Department of Insurance and Anthem Blue specified that the health insurer would extend benefits to Impacted Pathway Members — those individuals who enrolled in Pathway plans.
The extended benefits will allow those individuals to receive treatment from WellStar Health primary care physicians and specialists between Feb. 4 and Dec. 31, 2019. The benefit extension will not apply to outpatient services or hospital inpatient admissions at WellStar Health Hospitals occurring after Feb. 4.