Blue Cross of California|Faces Class Action

LOS ANGELES (CN) - Blue Cross of California illegally misleads its policyholders about their coverage and which providers are in the policyholders' network, a class action claims in Superior Court.

Samantha Berryessa Cowart sued Blue Cross of California dba Anthem Blue Cross for breach of contract, breach of faith and business code violations.

She claims that Anthem recently issued member identification cards that state, incorrectly, that many members are in Preferred Provider Organization plans (PPO) though they actually are in Exclusive Provider Organization plans (EPO).

"In PPO plans, members have access to a huge network of Anthem providers and the ability to obtain covered treatment from out-of-network providers," the complaint states. "Unlike PPO plans, in EPO plans, members only have access to an extremely limited network of providers and no coverage for out-of-network providers. When the members provide their member identification cards to Anthem PPO providers, the providers render services believing that the members are in an Anthem PPO plan. As a result, members receive services from these providers only to have Anthem ultimately deny coverage on the ground that the providers are not in-network EPO providers. Thus, Anthem has wrongfully forced potentially thousands of their members to pay out of pocket for medical costs."

Cowart seeks class certification, costs and exemplary damages. She is represented by Scott Glovsky, of Pasadena.

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