Blue Cross Blue Shield of New York sued over ‘ghost networks’
Thousands of patients have filed a class-action lawsuit against Anthem Blue Cross Blue Shield (BCBS) of New York, claiming the insurer committed fraud by disseminating a “ghost network” of physicians.
According to the plaintiffs, BCBS deliberately published an inaccurate directory of primary and specialty care doctors, implying they were in-network for those on the insurer’s health plans when they were not.
In a statement, attorneys representing the patients, from law firms Pollock Cohen and Walden Macht, said this directory caused “significant financial harm,” as patients in need of treatment went out-of-network to receive care that was not covered by their BCBS health plans.
For some patients, this meant significant delays in care or abandoning treatment altogether, the plaintiffs' attorneys said. They added that after hearing the patients’ stories, they conducted a “secret shopper” investigation, calling “100 doctors listed in the directory who supposedly accepted the BCBS insurance.”
Only seven of the 100 accepted BCBS insurance and would take new patients, the attorneys claim. The rest either did not accept the insurance, did not provide the necessary services or were unreachable, they added.
"We knew ghost networks were a problem, but we had no idea it was this bad," Steve Cohen of Pollock Cohen—one of the lead attorneys representing the plaintiffs—said in the statement. "Both the New York State Attorney General and the U.S. Senate have conducted similar secret shopper studies. But neither investigation was as extensive as the one we conducted on behalf of these plaintiffs. And the findings were just shocking—it is nearly impossible to find doctors who accept this insurance."
The lawsuit is primarily focused on patients seeking mental health services. In the lawsuit, two patients said they called dozens of doctors seeking treatment but were unable to find a provider who would take their BBCS health plan.
HealthExec reached out to a representative of BBCS but was told the company does not comment on pending litigation.
The full legal complaint, filed in a federal court in New York, can be found here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.