The city’s lawsuit claims that the directories of corporate health care providers were fake or inaccurate and confused consumers seeking networked care.
SAN DIEGO (CN) – San Diego City Attorney Mara Elliott on Thursday filed lawsuits against three California health insurance providers accused of misleading consumers by posting bogus health care provider directories or misleading.
Lawsuits in San Diego Superior Court claim that health insurers publish directories listing doctors and other providers not covered by consumer plans.
State and federal laws require insurers to publish accurate directories of networked healthcare providers for consumers, many of whom evaluate provider listings when deciding which insurer to register with.
The insurers named in the complaints – Kaiser Foundation Health Plan, Molina Healthcare of California and HealthNet – did not follow the law, according to the lawsuits.
“These bogus lists create formidable, dangerous and illegal barriers to patient care, hurting the public health and health insurance markets in California,” the San Diego attorneys wrote in the complaints. “These inaccurate directories, known as ‘ghost networks’, mistakenly describe the breadth of an insurer’s provider network, promising consumers access to health care that, in reality, is not available in the marketplace. the framework of the plan. “
False or inaccurate listings have left countless consumers frustrated with the unsuccessful search for care or burdened with costs from off-grid providers.
The actions of the defendant insurers also forced consumers to delay medical treatment or ignore a health proceeding entirely because of false information in supplier directories, according to the lawsuits.
Lawyers for the city allege that the Kaiser and HealthNet directories have inaccuracy rates of at least 35%, while Molina’s supplier directories can be up to 80% false or incomplete.
Kaiser, who has more than 9 million Californians enrolled in health plans, has an overall inaccuracy rate of 19% and one of the worst rates for mental health lists with 32% of psychiatrists in the directory being false or inaccurate lists.
An anonymous Molina plan person identified in the complaint said in a letter to the Better Business Bureau in March that she was frustrated after looking for care in inaccurate directories.
“I called dozens of suppliers from the Molina website. I even opened it up to ‘within 50 miles’ of my zip code, ”the letter wrote. “Every receptionist who answered says she DOES NOT ACCEPT Molina insurance. The website says it was updated yesterday, but when I ask these providers if they have taken Molina yet, most of them say they haven’t taken it for 3 years or more … I might as well not even have bought insurance.
Defendant insurers could illegally reap financial gains based on the enrollment of consumers who believe their health plans give them access to a vast network of providers, according to the lawsuits.
The complaints allege false advertising and illegal business practices.
Elliot said in a statement Friday that inaccurate supplier directories pose a danger to consumers and the public health system.
“Consumers should be able to trust their health insurers when seeking medical care,” Elliott said. “Directories filled with errors create dangerous barriers to health services, with patients struggling to find a physician listed in the directory who will accept their insurance. These deceptive ghost networks not only violate state law, but undermine the health of San Diego and Californians. “
Representatives of the defending insurers did not immediately respond to requests for comment on the respective lawsuits.