Anthem Blue Cross HMO Contract Dispute

A class-action lawsuit has been filed against Anthem Blue Cross, a major health insurance provider in California. This class-action lawsuit was filed by five doctors who claim that Anthem failed to provide adequate benefits for their clients and deny them the necessary care. The physicians say that they were denied proper treatment for diseases and conditions that could have been prevented with proper attention by Anthem. As part of the class-action lawsuit, the plaintiffs will receive a percentage of any monetary recovery.

Anthem Blue Cross is one of the largest health insurance providers in California.

The company also happens to be one of the largest shareholders in California’s largest insurance company, Aetna. Recently, The California State Attorney’s General filed a criminal complaint against Aetna, saying that Aetna charged more for individual policies than it should have. The complaint says that Aetna’s policyholders were subject to “unfair and deceptive” policies and practices, which caused them to pay higher rates. It is alleged that this form of “bad faith insurance” caused Anthem to profit while leaving their customers’ health bills unpaid.

If you’re part of the class action or know of anyone who is, it would be wise to contact an experienced personal injury attorney. The role of this type of attorney is to gather facts and build a case from them. If you’re involved in a state lawsuit like the one filed in California against Anthem, it’s always best to seek the advice of an attorney who specializes in personal injury cases. You may not be aware of it, but there are several class-action lawsuit plaintiffs in other states who have won substantial settlements. You can ask other attorneys who have gone through what you’re going through if you’re looking for hints or tips. If you’ve already done some research on your own, that’s great, but the knowledge of an experienced attorney can only help.

A few things you should know about the lawsuit filed against Anthem Blue Cross by the California Department of Insurance are:

The suit was filed because of an unreasonable denial of a request for group health insurance coverage. As defined in the statute, any person who “forcibly” makes a request for group health insurance coverage — through no fault of their own — is considered to have been declined that coverage. In this situation, the denial was made based on the fact that Anthem “erred” in making its decision and did so for the “purpose” of denying coverage to a certain group of people. This is a legitimate claim, and it’s important to understand that it has the possibility of being awarded.

The complaint alleges the following: Anthem failed to provide reasonable notice to applicants prior to denying their applications, and did not inform applicants of its denial until after denying their initial request. Also, Anthem failed to take reasonable steps to investigate the health risks of its proposed HMO contract with Blue Cross, and did not allow adequate data to be used in the underwriting process. Finally, the complaint alleges that Anthem repeatedly violated the statute’s mandates and that it adopted methods of enforcement that were deceptive and abusive. This article will address the complaint and some of the arguments presented to show why the complaint is valid.

The complaint, in this case, focuses on two areas — what failed to provide notice of denial, and the method of enforcement itself.

First, the complaint notes that the notice of denial provided to Anthem did not give the applicant enough time to reasonably avoid the denial. Moreover, the complaint says that it is not legally binding, as the denial letter itself is not proof of the health risks posed by the HMO contract. Finally, the complaint further says that the methods used by Anthem in determining eligibility for HMO contracts — a process that the complaint describes as “a process of guesswork” — are also deceptive. On an overall basis, the complaint states that this case is “basically an attempt to force health insurance companies to act according to their will, and at the expense of the individual subscriber” (italics added).

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