Earlier this month, Doss Law Firm announced its class action lawsuit against Anthem health insurance (formerly Blue Cross and Blue Shield of Georgia). Listen below as Atlanta attorneys Jason and Joy Doss discuss the case. We also heard from soon-to-be former Wellstar patients about how Anthem’s actions have affected them, as well as members of the media.
Audio Link: Doss Firm Discuss Anthem Lawsuit
Speaker 1: Hello and welcome to this news event sponsored by the Doss law firm. You’ll be hearing from four speakers today. Before we introduced them individually, I want to bring the operator on to explain how the Q and A period will work in the latter portion of the call.
Speaker 2: Thank you ma’am. During the question and answer session, you may ask a question by pressing star, then one on your touch tone phone. If any time a question has been addressed and you’d like to withdraw your question, please press star then two. We please ask that you limit yourself to one question at a single follow up. If you need to ask an additional question, please know that you may press star then one to rejoin the queue. Thank you.
Speaker 1: We will repeat those instructions about how members as a news media can pose questions at the start of the Q and A period. As I mentioned, you will be hearing from four speakers today. First will be Jason Doss, attorney from the Doss Firm LLC. Second, Joy Doss, attorney also from the Doss Firm LLC. Francis Kirby is third of Marietta area woman. And then fourth is John David Marks, an Atlanta area man. Let’s begin with our first speaker attorney Jason Doss.
Jason Doss: Good afternoon. My name is Jason Doss. I’m an attorney with the Doss Firm LLC in the Atlanta area. I want to thank you for joining us today. I will be making brief introductory remarks, and then take your questions later during the Q and A period. Today our firm filed a class action lawsuit on behalf of Ms. Kirby and Mr. Marks as well as thousands of Georgia healthcare consumers who were misled by deceptive marketing scheme perpetrated by Anthem Blue Cross. Specifically, thousands of Georgia consumers were misled during the 2018 open enrollment period by misrepresentations and omissions from Anthem Blue Cross Blue Shield of Georgia. When these consumers were told at the time of enrollment that they would continue to have access to the doctors and specialists of Georgia’s largest healthcare provider Wellstar Health System Inc., as an in-network provider. As stated in the complaint, Wellstar informed the public that, in fact, Blue Cross had terminated their relationship in August of 2018, which was several months before the open enrollment period began. And yet Blue Cross continued to advertise that Wellstar was an in-network provider.
Some of you may have seen a recent news release by Anthem. I think was issued yesterday. I want to be clear that our lawsuit is proceeding, since the 90 day extension announced in the last 24 hours by Anthem is at best a limited and bandaid non-solution, that only extends the uncertainty, shifts the burden onto the patients and consumers yet again, and the suffering of the soon to be former Wellstar patients. The lawsuit was filed in the United States district court for the northern district of Georgia, Atlanta Division, on behalf of plaintiffs Francis Kirby and John David Marks, which in the complaint reads in part as follows. Quote “during the most recent open enrollment period which was from November one, 2018 to December 15, 2018, Anthem made uniform misrepresentations and omissions to consumers despite the fact that Anthem informed Wellstar in August of 2018, that it would not be including Wellstar as an in-network provider for individual health plans known as the Pathway plans, during the 2019 coverage period.”
The lawsuit continues, quote “Anthem never informed consumers of this fact and engaged in a deceptive marketing scheme to continue to list Wellstar providers in-network during the open enrollment period. Anthem continued to use its marketing material disseminated to their agents, as well as on its website, falsely representing that Wellstar physicians and facilities would be in network providers for Anthem’s Pathway health insurance plan.
There is some context of interest here. Anthem Blue Cross has faced similar litigation in the past. Class action lawsuits were filed in California a few years ago based on a similar deceptive marketing scheme, in which the company overstated their network in their marketing materials, and when people signed up, they had far less than what they were promised. That lawsuit, my understanding is it settled for approximately $23,000,000, and that Anthem agreed to make business changes going forward to prevent future problems in California.
So what does all this mean? The facts here are clear. Anthem concealed the truth from Georgia health consumers for the purpose of inducing them to select them at their health insurance company. What this boils down to is Anthem was basically perpetrating a bait and switch on their consumers based on false advertising. You can’t tell someone that their regular doctors and specialists will be available when you know before your open enrollment advertising campaign begins, that you had no intention of honoring your promise. That is what Anthem did here, and that concludes my opening statement. I look forward to taking your questions shortly.
Speaker 1: Great. Again, ladies and gentlemen, that was Jason Doss. Let’s precede to our second speaker, attorney, Joy Doss.
Joy Doss: Good afternoon. My name Joy Doss, also an attorney with the Doss law firm here in the Atlanta area. I too will be making brief introductory remarks, and then be available for your questions later during the Q and A period. It’s important for people to understand just how bad of a situation this is. Wellstar is the largest healthcare provider in Georgia and virtually the exclusive health care provider in Northwest Metro Atlanta. In 44 counties in this state, Wellstar is the sole healthcare provider. By falsely holding out the lure of Wellstar of doctors and specialists and then yanking that away, Anthem was able to lure customers into its net, and then severely disadvantaged them after the fact.
Now that the open enrollment period is closed and these consumers are locked in to 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. These misled consumers are now expected to continue paying Anthem’s premiums for a health insurance product they would not have purchased had they known the truth. And if plaintiffs want to continue using their existing Wellstar doctors, they will have to pay the full price for medical treatment, as if they did not have any health insurance at all. It’s important to keep in mind that we’re talking about real people here who have been harmed. I want to say a few words to introduce our healthcare consumers speakers today. Ms. Francis Kirby has significant health issues and requires nine specialists. She will be forced to replace the majority of her specialists as most are Wellstar providers, as well as her primary care physician from whom she has had treatment for approximately 20 years.
John David Marks has had significant health problems since 2004, and was diagnosed with prostate cancer in 2016. He will no longer be able to see the same Wellstar physicians and specialists for treatments. These are just two of the thousands of Georgia healthcare consumers harmed by Anthem. These victims are the reason that we went to court today. Anthem is an enormous healthcare company with vast legal resources available to them. They cannot be allowed to just trod all over people like Ms. Kirby and Mr. Marks. We are very proud at the Doss firm to be able to represent them. That concludes my opening statement and I look forward to taking your questions.
Speaker 1: Okay. Again, that was attorney Joy Doss. Let’s go to our third speaker, Francis Kirby, a Marietta area woman.
Francis Kirby: Hello, this is Mrs. Kirby. I received no notification of this change from Anthem and had to read about it in a news release. Because my longterm primary care physician and several of my specialists are Wellstar providers, I will now be forced to search for a new primary care physician, and several new medical specialists. This will assuredly cause a lapse in my medical treatment. I must find several new doctors with whom I am comfortable, and who are accepting new patients. I’ve had to be hospitalized several times over the years. And now where am I gonna go? Wellstar operates the only hospitals available to me currently in Cobb county.
Speaker 1: That was Francis Kirby. And now we’ll proceed to our fourth and final speaker, John David Marks, an Atlanta area man.
John David Mark: Hello this is Mr. Marks. I had an appointment set for today with my Wellstar urologist, and had to cancel due to a lack of coverage. All my specialists are with Wellstar, and Anthem has cut them all off, after I was assured they would be available to me. What I’m left with is far from satisfactory. Nearly all the specialists where I live are Wellstar specialist. In addition, the closest hospital that Anthem will let me use is in midtown Atlanta, over 25 miles from my home. And that is extremely concerning given that I have heart problems, and could otherwise go to Wellstar facility, just five minutes away.
Speaker 1: All right, and again that was John David Marks. That takes us to the Q and A portion of the call. I want to emphasize that the Q and A period is for reporters only, and I want to bring the operator back on the line to explain once again how members of the media may ask a question.
Speaker 2: Yes, ma’am. At this time, if you will like to ask a question, please press star then one on your touch tone phone. If any time a question may have been addressed and you’d like to move yourself from the queue, you may press star then two. Again we please ask you limit yourself to one question and a single followup. If you need to ask additional questions, please know again that you may press star then one to rejoin the queue.
Speaker 1: While we are waiting for our first question, I want to make sure you know that if you wish to connect with any of the speakers you’re hearing following this call, you may contact Whitney Dunlap at 703-229-1489. Okay Operator, let’s start with our first question.
Speaker 2: Yes ma’am. That question will come from Ariel Heart with the Atlanta Journal Constitution.
Ariel Heart: Hi, can you hear me?
John David Mark: Yes.
Jason Doss: Yes.
Speaker 1: Yes.
Ariel Heart: Okay, great. Do you all have any idea how many patients are affected by this?
Jason Doss: So this is Jason Doss. The news reports as you will know, reported that there were thousands of consumers who were impacted. This is a statewide class, so it includes people even outside of Metro Atlanta. Also I have spoken with several brokers who were selling individual insurance, and they’ve reported to me that they’ve got hundreds and hundreds of people that have complained to them since this news broke. So I suspect the answer is that there’s thousands of consumers who are negatively impacted.
Joy Doss: But we don’t know for sure.
Jason Doss: Not yet.
Ariel Heart: Okay, thanks.
Speaker 1: Okay is there another question operator?
Speaker 2: Yes ma’am. The next question we have will come from Rickie la Rue, with the Marietta Daily Journal.
Rickie: Hi, can you guys hear me?
Speaker 1: Yes.
Jason Doss: Yes.
John David Mark: Yes.
Rickie: What is your ultimate goal with this class action lawsuit? What are you hoping to accomplish?
Jason Doss: This is Jason Doss. We’re hoping to accomplish two things. Number one, we’re seeking to recover any damages that were caused by Anthem’s deceptive practices. Those damages are going to end up being quantified through an expert witness, but they will include but are not limited to any out of pocket expenses that were incurred. And then separately also the harm caused in terms of a lack of access to the healthcare provider that they signed up for.
The third thing that we would be seeking would be business practice changes, to ensure that this never happens again. It’s my understanding that there is a dispute between Anthem in Wellstar that’s the cause of this. The dispute though, sounds like it was going on well before the open enrollment period. And so it just logically follows the Anthem knew at the time that it entered the open enrollment period, that they didn’t have a deal with Wellstar. And yet they represented to these consumers that they did. So I hope that answers your question.
Rickie: Uh, yeah. One followup would be the lawsuit mentioned that the damages could be higher than $5 million. Is that just a threshold, a legal threshold that you have to state in the filing? Or do you have an estimate of what you guys are looking for in terms of damages?
Jason Doss: Well, the estimate is that it’s more than $5,000,000. That is a jurisdictional amount as well, but we believe it’s well in excess of $5,000,000.
Rickie: Okay. Thank you very much.
Speaker 1: All right operator. Let’s go to our next question.
Speaker 2: Yes. That will come from Chris Mar, with the Bloomberg Law.
Chris Mar: Hi. This is Chris. I want to see if you could clarify for me … I see that Wellstar is unavailable under Anthem’s Pathway health plan. I’m not sure–is that one of many plans that Anthem offers in the state? Or is that sort of the only one or the primary one?
Jason Doss: Joy, do you want to handle this one?
Joy Doss: Yes. Joy Doss again. The Pathways plan is a plan that’s purchased by individuals and families under the Affordable Care Act, so these are not individuals that are covered by their employer. They’re individuals who have gone to either the private market and purchase what Blue Cross would call their online Pathway of plans, but it’s all under Pathways. Or they went to the government marketplace website and purchased insurance through there. Does that answer your question?
Chris Mar: Well part of it, but I guess the other part of that is, okay, I understand that this was purchased by individuals. It’s not employer sponsored coverage. But is this the only Anthem plan that’s available when you-
Joy Doss: Yes.
Chris Mar: Yep.
Joy Doss: In that situation, outside of the group plans? Yes. It’s the only plan available. Now there’s different layers of plans, whether it be silver, bronze, gold, depending on whether you purchase it through the marketplace or privately. But, and that just affects your deductible. But in Georgia it is the Pathways plan. Yes.
Chris Mar: Alright okay
Speaker 1: Before our next question, I’d like to invite the operator on the line again, just to remind members of the media how they can ask a question. Operator?
Speaker 2: Again if you’d like to ask a question, please press star then one on your touch tone phone. To remove yourself from the question queue, you may press star then two. Again, it is star then one to ask a question.
Speaker 1: All right, operator, let’s go to our next question.
Speaker 2: Yes ma’am. That question is a followup from Ariel Heart, Atlanta Journal Constitution.
Ariel Heart: Hi. What are your chances of getting certified as a class? I think you mentioned a suit in California. Did they end up getting certified in the class? And would there be different hoops to get through in Georgia?
Jason Doss: So this is a classic consumer fraud case, and I believe it has a very good chance of getting certified as a class. The reason that I think that is that the information in the marketing materials that Anthem disseminated to the public were uniform. So they had on their website, a ‘Find your physician” function which they encourage people to go onto before they enrolled, which listed the doctors and providers uniformly to people and made a uniform misrepresentation about that.
The other things that they misrepresented were also to the agencies, independent agents that were selling these policies to consumers, because those people also had marketing materials that were provided to them that were uniform. I’ve started gathering some of them already, and they’re going to be used as evidence in our case, of information provided by Anthem to the agents during the open enrollment period, saying that the Wellstar hospitals and providers showing which ones were and weren’t … Whether they were in the network, and they were. So, I think uniformity, the uniform misrep nature of this scheme makes it more likely, the common questions and facts are going to predominate over individual questions. And so the second thing, reason that I think that way is that there’s also a uniform omission. They didn’t disclose to anybody at the time of enrollment that they in fact … They had already previously terminated their relationship with Wellstar. So had that been disclosed, people wouldn’t have purchased the product.
So those are the types of facts that you look at in evaluating class case. And we believe we have a very good chance of getting certified.
Ariel Heart: Thank you. That’s helpful. And I did want to ask about what you just said. So I had spoken to some DOI officials before the February fourth date rolled around, and they said that they were looking into my question about this termination. I guess they didn’t know about it before then. And they found … I don’t know if you’d call it an announcement. But they found some kind of communication from Anthem to its customers within the portion of the website that allowed for customers to look for their providers. But I don’t know what they saw, but it was divorced from the actual list.
So my question to you is, did that communication exists as far as you know? Are you saying that that was not even there before January first of 2019?
Jason Doss: Let me have my clients answer that question. I think they’re in the best position to tell you what was supposed to [crosstalk 00:20:36]
Ariel Heart: Oh, I would enjoy hearing from them. So basically you don’t, aside from whatever your clients have told you, do you have knowledge one way or the other of what existed on website at that time?
Jason Doss: The answer is yes, I do know what was on Anthem’s website at the time, and listed the providers for Wellstar has covered. There was no asterisk or something that I saw that said otherwise. If there was, it wasn’t adequate obviously. And it didn’t contradict. So I hope that answers your question.
Ariel Heart: It does, and obviously we’re not in discovery yet, so okay, thank you.
Speaker 1: Okay. I believe that that was all the questions we had on the line today. I want to make sure that you know where to get more information about today’s news conference. To connect with any of the speakers you have heard from today and get more information, you can contact Whitney Dunlap at 703-229-1489. A streaming audio replay of this news event will be available online as of four PM at Dossfirm.com, or https://www.dossfirm.com/. The URL is linked on the news release, which should be in everyone’s inboxes by now. But if you haven’t received it, please contact Whitney Dunlap. Thank you for joining this news events sponsored by the Doss law firm. And that concludes today’s event.