Anthem Blue Cross Sued Over Deceptive Policy Marketing
November 8, 2013

Throughout the entire "If you like your insurance, you can keep it" media debacle, insurers have escaped scrutiny, even when some responsible media outlets are actively debunking claims made all over Fox News.

No one has been asking many questions about how it came to pass that people with policies that would have been grandfathered no longer have those policies? What made them switch, and why?

Anthem "Twists" Their Policyholders

Two lawsuits filed in Los Angeles this week shed some light on that question. Both allege they were actively pursued by Anthem Blue Cross to switch their policies from a grandfathered contract to a newer one. Because they had pre-existing conditions, Anthem offered to make the switch without any medical underwriting process, which meant they could transition to the new products without any exclusion for their pre-existing condition.

Both chose to make that switch, and both received cancellation notices from Anthem this month informing them they would have to shift to an ACA-compliant product with much higher premiums or shop on the exchange.

Here's the problem. Anthem has chosen to limit their provider networks for the exchange policies, leaving the possibility wide open that people who have doctors they like won't get to keep them under the exchange policies, but instead will have to purchase the non-exchange policy to keep their doctors, forcing them into a higher-cost product than they could otherwise purchase.

Had they not been "twisted" out of their grandfathered policies, they would have been allowed to keep them, and their providers.

Why would Anthem do this?

Profits, profits and profits. As one of the lawsuits alleges, "Blue Cross had a financial incentive to eliminate grandfathered plans from the marketplace...[limiting] the network of providers available on its new ACA plans in order to save a significant amount on administrative costs."

California has specific laws in place to stop this practice, called "twisting." In life insurance markets, agents would get their policyholders to replace older policies with new ones in order to reduce the cash value of the policy and earn higher commissions. The same principle is in play here, and they did it to thousands of Californians. I can recall getting questions about it back in 2010 when they were calling policyholders to entice them into newer plans.

Who lied and who didn't?

If you accept President Obama's claim that his promise was based on the belief that grandfathered policies would be maintained and not actively undermined by insurers, then the real lying liars here are health insurers who intentionally misled customers to make a switch that they knew well in advance would have twin consequences of harming policyholders and harming the ACA.

Peeking into my health insurance crystal ball

Insurers had another incentive to limit provider networks under the new exchange plans, and it has nothing to do with administrative costs. The second pillar of the President's promise was that if you liked your doctor, you could keep your doctor. By limiting networks, health insurance companies get a second bite at the negative PR apple for the ACA.

Just wait, because I promise you that will be the next faux scandal. After this one dies down, the next one will be a huge outcry, beginning on right wing blogs and moving to the cable news forefront, where individuals begin to really shout about not being able to keep their doctors.

Once again, the blame will be on the law and the President, instead of on insurers where it belongs. If they keep it up, they're going to discover a couple of realities. One, people like having access to health care, and two, they don't like being lied to by the corporate entity standing between them and that health care. If they hold to their hard-line resistance to the ACA, there will be a bipartisan shout for Medicare for All, which will end their days of fun and profit forever.

Simon v. Anthem Blue Cross Life and Health Insurance Co by Karoli

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