Health Insurance
Anthem, Empire Union Health Funds Hiding Claims Data, Says ERISA Class Action
The Employee Retirement Income Security Act (ERISA) also governs some health plans provided to employees or union members. In this case, two union self-funded health funds have sued Elevance, Inc., Anthem Health Plans, Inc., Anthem Blue Cross, Empire Blue Cross Blue Shield, and Empire Blue Cross (collectively called “Anthem” in the complaint), alleging that the Read more
Centene Ambetter Health Insurance Plans Performance RICO Class Action
Ambetter health insurance plans are sold on the exchanges established by the Affordable Care Act (ACA). This class action brings suit against those who provide the plans, including Centene Corporation, Centene Management Company, LLC, and Celtic Insurance Company, alleging they sell fraudulent health insurance policies and bringing suit under the Racketeer Influenced and Corrupt Organizations Read more
Colonial Life & Accident Oral Chemotherapy Benefits Class Action
Colonial Life & Accident Insurance Company offers a cancer insurance policy that covers “oral chemotherapy” drugs—but what exactly does it pay for? The complaint alleges that a sentence in the policy is at issue: “the cost of the prescription for the day you have the prescription filled, up to the amount shown in the Schedule Read more
Cigna Health and Life Insurance and Multiplan Underpayments Class Action
Like most insurers, Cigna Health and Life Insurance Company has contracts with certain entities who are its in-network providers. But it also has an agreement with a complementary entity called Multiplan, which is supposed to apply to payments to out-of-network providers who also participate with Multiplan. But the complaint alleges that Cigna does not pay Read more
Adventist Health Plan Must Meet ERISA Requirements, Says Class Action
When is a company’s employee health plan governed by the Employee Retirement Income Security Act (ERISA)? Adventist Health System West (AHW), which does business as Adventist Health offers the Adventist Health Employee Medical Plan—Engaged!, which it claims is a church plan and does not fall under ERISA. The complaint brings suit against the complaint, the Read more
Caring for Montanans Illegal Subrogation Claim Montana Class Action
This class action concerns an argument over who gets the proceeds from a lawsuit over a failed hip replacement. It brings suit against Health Care Service Corporation and Caring for Montanans, Inc., formerly known as Blue Cross and Blue Shield of Montana, Inc., which the complaint refers to, collectively, as Blue Cross. Blue Cross claims Read more
BCBS of Illinois LGBTQ Discrimination in Infertility Treatments Illinois Class Action
Do health insurance policies cover fertility treatments? And if so, do LGBTQ individuals have an equal right to receive them? This class action alleges that Health Care Service Corporation, which does business as Blue Cross and Blue Shield of Illinois (BCBSIL), discriminates against LGBTQ people, because it imposes more onerous and expensive prerequisites on them Read more
Blue Cross Denial of Coverage for Mental Health Treatment Class Action
This class action concerns parity—the requirement that mental health treatment be addressed in an equal manner to physical illness, under the federal Mental Health Parity and Addiction Equity Act. The case brings suit against insurer Blue Cross and Blue Shield of Texas for its denial of benefits for the plaintiff’s son at a residential treatment Read more
BCBS of New Mexico Improper Denials of Care New Mexico Class Action
Health insurance companies may refuse to authorize novel or unproven treatments, or procedures that don’t meet their guidelines. However, the complaint for this class action alleges that Blue Cross and Blue Shield of New Mexico, a company of Health Care Service Corporation, routinely refuses patients services and forces them to go through appeal processes, to Read more
Aetna Denies Insureds L-ADR Surgery Class Action
At issue in this class action are certain policies of the health insurance offered by Aetna Life Insurance Company. The complaint alleges that Aetna will not pay for its insureds to have lumbar artificial disc replacement (L-ADR) surgery, alleging that it is “experimental and investigational.” But the complaint claims that this is not true, that Read more