Insurance commissioner orders hearing on WellStar/Anthem dispute

May 13, 2019

Georgia’s insurance commissioner has alleged that based on complaints the commissioner’s office has received, Anthem appears to have violated state law related to the health insurance company dropping WellStar as a provider.

Insurance Commissioner Jim Beck has scheduled a hearing for May 29 in Atlanta. At the hearing, Anthem will be asked to give reasons why Beck’s office shouldn’t take action against them for their alleged violations, according to the order Beck signed Friday.

“I am committed to protecting Georgia families. I am looking forward to hearing from both Georgia’s consumers and Anthem Blue about what transpired, particularly as it relates to WellStar patients,” Beck said in a statement.

Beck’s order states that based on allegations his office has heard, “it appears that Anthem Blue has been engaged in or is engaging in an unfair method of competition or an unfair or deceptive act of practice in the business of insurance.”

Beck’s involvement is the latest episode in the conflict between WellStar and Anthem.

In August, Anthem notified WellStar that in early February, 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 alleges 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.

Marietta attorney Jason Doss, who filed the suit, has called Anthem’s actions a “bait and switch” on its customers.

Now, Beck’s office is getting involved in the dispute. In a news release that accompanied his order on Friday, his office outlined the potential consequences for Anthem, which owns Blue Cross Blue Shield Healthcare Plan of Georgia.

“After the hearing, if the Commissioner finds that Blue Cross engaged in unfair trade practices, he may order Blue Cross to pay fines and order other relief as is warranted,” according to the news release.

In a statement, a spokesperson for Anthem said the health insurer has worked closely with Beck’s office to help those affected by dropping WellStar.

“Anthem has worked closely with Commissioner Beck and the Department of Insurance throughout 2019 to assist consumers who wrongly assumed WellStar would be in the Pathway network. Anthem has provided numerous options to help those consumers, and Anthem will continue to work with the Commissioner on these issues,” the statement reads.

The spokesperson goes on to say that Anthem hasn’t done anything wrong and will have representatives at the hearing to testify as such.

“With respect to the Commissioner’s request for a hearing, Anthem will be present at the hearing and present information that makes clear that Anthem has done nothing that is misleading, unfair or deceptive. Anthem will continue to work to ensure our members receive high quality, affordable care through our network of participating providers and hospitals,” the statement reads.

Doss, who is representing six named plaintiffs in the suit, said he’s encouraged that the state is taking the situation seriously.

“They’re trying to help consumers,” Doss said.

He said he’s planning on attending the May 29 hearing with Insurance Commissioner Beck and expects his clients to testify.

The class action suit, originally filed in federal court, has been refiled in Cobb Superior Court, Doss said. The case is pending with Judge Tain Kell, Doss said, waiting for an answer from Anthem as to the suit’s allegations. Doss said there are a few advantages to having the case in Cobb Superior Court.

“Number one, you’ve got a Georgia court judge interpreting Georgia law, as opposed to a federal judge interpreting Georgia law,” Doss said. “Secondarily, Cobb County is ground zero in this case. … This all started because of the WellStar dispute and Anthem falsely listing WellStar as in network when they weren’t.”

Doss said he’s also been pushing the federal Department of Health and Human Services to order a special enrollment period for those affected by the Anthem/WellStar dispute. This would allow these Anthem customers to sign up for a new insurance plan outside the regular open enrollment periods that take place late each year, Doss said.

“My hope is that there will be findings of fact (at the hearing) that show that Anthem violated Georgia law, which would be helpful not only to the class-action case I’ve got filed, but also getting the federal agency … to create a special enrollment period,” Doss said.

He’s also considering filing a separate federal lawsuit that would force HHS to open the special enrollment period, but has not done so yet.