Centene sued over allegedly ‘fictitious’ provider networks in ACA plans

The largest insurer on the Affordable Care Act (ACA) exchanges, St. Louis-based Centene, has been sued over allegedly deceiving customers over how many providers accept its plans, with many reporting they had trouble finding an in-network physician using Centene’s insurance.

First reported by Bloomberg, the lawsuit said Centene’s Ambetter plans even listed physicians as taking its coverage when they didn’t.

“After purchasing an Ambetter insurance plan, they learn that the provider network Centene represented was available to Ambetter policyholders was in material measure, if not largely, fictitious,” the suit said.

Centene has been expanding its ACA presence, now covering 1.4 million people through exchange plans. In 2017, it stepped into many counties which were at risk of having no ACA insurers and remained the lone choice of insurer for exchange customers there.

While most ACA exchange plans are of the narrow-network variety, Centene’s own network adequacy has been questioned before. Washington briefly halted sales of Centene plans late in 2018 over a lack of providers in its network, and sales were only restored once the company agreed to outside monitoring.

The claims in this lawsuit, however, were quickly denied by Centene spokeswoman Marcela Hawn.

“Our networks are adequate and we work in partnership with our states to ensure our networks are adequate and our members have access to high-quality health care,” she said.

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