Health plan participants have the extra support of legal prosecutors if their health plan providers rescind their policies as a result of illness, thanks to a recent court decision. California health companies have already had to pay more than $13 million in fines to regulators as a result of having rescinded health policies for sick patience.
Health companies may have hoped that the fines would make the scrutiny over their practices go away, but, instead, legal experts expect the scrutiny to continue. The California state Court of Appeal ruled in December 2009 that prosecutors would be permitted to sue health insurance companies over the insurance companies treat consumers and their members.
The recent legal ruling is a result of a lawsuit against health giant Anthem Blue Cross of California. Prosecutors argued that Anthem violated state law by selling health plan members the promise of health insurance, but then later rescinding the health coverage after health insurance plan policy holders submitted their claims for medical care.
After the lawsuit was filed, Anthem Blue Cross argued that the company’s practice of rescinding health coverage fell under the jurisdiction of the California state Department of Managed Health Care; not the Los Angeles city attorney’s office. The city’s attorney’s office filed the lawsuit in 2008. Anthem Blue Shield and the state agency filed paperwork defending Blue Cross. Blue Shield is a competitor of Blue Cross of California and faces a similar law suit by the city’s attorney.
In response to Blue Cross’s argument, the appellate court said that the law was “unambiguous” and gave the city attorney the right to sue the insurance company. The ruling allows the city to not only pursue its current lawsuits against insurance companies, but it also gives the city more influence down the road in other areas.
“This puts new cops on the beat,” said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. “Lots of stuff in the standard operating practices of health plans is going to be affected by that decision.”
Additionally, Los Angeles City Atty. Carmen Trutanich said he agreed with the appellate court’s ruling. “I am committed 100% to pursuing our litigation against these insurers,” he said. “Illegally canceling people’s healthcare coverage after they get sick is unconscionable.”
Moreover, Los Angeles Assistant City Atty. James W. Colbert III suggested that the recent ruling against health insurance companies may encourage prosecutors in other cities to review the practices of health insurers in their areas. “This decision invites that kind of interest,” he said.
Anthem Blue Cross has yet to decide whether it will appeal the decision, but some believe that the company should be worried about the negative fallout of the unfair business practices.
However, the managed healthcare department said that prosecuting health insurance companies by local government offices is “duplicative regulation” that actually undermines process that has been made to “ensure quality, accessible healthcare.” As a result, some realize that health insurance companies will …