Health

Anthem Health Care Customers Sue Over WellStar Split

Anthem’s contract with WellStar lapsed earlier this week, making the health care company’s providers out-of-network.
Anthem’s contract with WellStar lapsed earlier this week, making the health care company’s providers out-of-network.
Credit Michael Conroy / Associated Press
'Add to My List' icon 'Added to My List' icon Add to My List In My List

A group of Georgians who signed up for Anthem individual insurance during the last open-enrollment period are suing the company over its recent break with health care provider WellStar.

The class-action complaint, filed Tuesday, argues the insurance company misled consumers when it said WellStar would be in-network for customers with its Pathways plan.

Anthem’s contract with WellStar lapsed earlier this week, making the health care company’s providers out-of-network.

“Now that the open-enrollment period is closed and these consumers are locked into a new health insurance contract, Anthem pulled the rug out from under them and is now no longer including WellStar as an in-network provider,” said Joy Doss, an attorney representing the plaintiffs.

The contract lapse does not affect Georgians with employer-sponsored Anthem plans. The insurer offers its Pathways plans through the Affordable Care Act health exchange.

After the contract expired Monday, Anthem announced Pathways customers could continue to see WellStar providers for a 90-day period, until May 4, 2019, without paying out-of-network prices. Though, that offer came with caveats.

“We cannot guarantee that WellStar will permit Pathway Members to schedule appointments, nor can we guarantee WellStar will not bill members for the difference between the Anthem allowed reimbursement and WellStar’s billed charges,” Anthem said in a release.

Jason Doss, another attorney on the lawsuit, says the offer of extended coverage from Anthem doesn’t go far enough.

“The 90-day extension announced by Anthem is at best a limited and temporary Band-Aid nonsolution that only extends the uncertainty [and] shifts the burden onto the patients and consumers yet again,” he said.

Doss says thousands of Georgians are likely to be affected by the contract lapse. WellStar operates 11 hospitals in the state, many of those in the northern Atlanta suburbs.

When reached for comment Tuesday, a representative for Anthem said the health insurer does not comment on pending litigation.