The lawsuit was filed by Centene’s customers against Ambetter plans through the individual insurance marketplaces in the U.S District Court for the Eastern District of Washington.
Centene is facing a federal lawsuit alleging its plans that will not work to provide adequate access to in-network providers.
The lawsuit blames Centene for selling junk plans on state transfers and misleading enrollees wherein the plan benefits, which will not be going to follow the ACA’s requirements that health care insurance will provide sufficient coverage. According to a release from the law firms serving the plaintiffs. Admittedly, the charge says that Ambetter policyholders throughout the nation report strikingly related problems when attempting to use their health coverage.
The lawsuit also alleges that Centene regularly neglects to pay providers’ rightful claims, which reduces its provider network by leading a huge number of providers just to reject Ambetter insurance.
In an email sent from Centene, it stated that FierceHealthcare and the company have not yet been served with the filed lawsuit.
Kreidler noted that his office has been partnering with Coordinated Care to fix the problems since May, 140 customers are complaining about receiving surprise medical bills.
Centene was permitted to continue selling ACA plans less than a week later it agreed to make the issues and pay a $1.5 million fine.
No the same with other major openly sold insurers, which have mainly drawn back from the ACA exchanges, Centene took a bullish approach and expanded into new regions in 2018.
This week, CEO Michael Neidorff announced the insurer had enrolled more than 1.4 million people in marketplace plans as of Jan. 7—an increase of more than 400,000 connected to the third quarter of 2017, according to Reuters. Previously, Neidorff attributed the company’s third-quarter revenue addition to the majority of its marketplace business.
Centene is also the nation’s largest Medicaid managed care plan, and according to PwC. And it’s touching to get even larger, as Centene announced a deal in September to acquire New York-based Fidelis Care for $3.75 billion.
Washington regulators have raised an order forcing Centene to stop exchanging single market plans in the state, presented the insurer gives a fine and makes issues with its provider networks.
Here’s some brief research:
- Centene said it has more than 1.4 million people signed up in ACA plans and an increase of more than 400,000 compared to the third quarter of 2017
- Networks for Centene’s ACA plans, marketed as Ambetter, were so skimpy that customers were pressed to find providers who would take their insurance. In some cases, doctors listed as being in the network did not accept it either.
- Two individuals who purchased Centene Affordable Care Act plans have filed a lawsuit against the insurer alleging the plans were leaner than advertised.
In July, the company announced it would be offered Ambetter in 40 countries in Missouri. Centene has expanded its ACA footprint even as other insurers have pulled out of the exchange market. 25 more countries are included that were facing the possibility of no ACA options this year.
Way back then Centene had 1.2 million members in exchange plans, up from 537,000 at the end of the year 2016.
The allegations against Centene come as the Donald Trump administration is moving toward narrower networks in ACA exchanges.
Last fall, President Trump approved an administrative order health plan benefit requirements and then said he would end cost-sharing reduction subsidies for insurers. The linked moves flagged the way for more market confusion by providing for schemes with limited coverage and any limits on out-of-pocket costs. Small networks are not unknown in the ACA exchange market. They are recently reported that close to three-fourths of its ACA market includes more definitive systems — up from 68% in 2017.
Any critics say assigning cases to a more modest pool of doctors and hospitals could help reduce healthcare costs by allowing payers to sell cheaper prices, commencing to lower premiums and out-of-pocket costs for enrollees. But to work, these small networks must offer high-quality providers with proven results.
The plaintiffs in Harvey v. Centene Corp. are trying class-action status on behalf of all Ambetter customers.
