Anthem ACA plans misinform WellStar patients that they’ll be in network

(AP Photo/Michael Conroy, File)

(AP Photo/Michael Conroy, File)

Postings for Anthem health insurance plans have again misinformed customers on the Affordable Care Act exchange, telling them WellStar Health System will be in the insurer's individual network. It won't.

On Tuesday, 19 days into the sign-up period for 2020 plans on the ACA exchange, the Georgia Department of Insurance announced that Anthem’s Pathways networks do not include WellStar. That’s contrary to what Anthem plans had advertised on the marketplace exchange as customers shopped. Customers can still switch plans until the enrollment period closes Dec. 15.

A spokeswoman for Anthem, Christina Gaines, said a technical error caused the problem.

“We are committed to working with the Georgia Department of Insurance on notifying consumers,” she said. “We have submitted an updated database file to (the ACA exchange), and we are working with them to ensure the accurate display of information as soon as possible.”

She added that Anthem would assist customers who want to switch.

WellStar is the major health care provider in northwest metro Atlanta, with nearly a dozen hospitals and 250 medical office locations. No other system has hospitals in Cobb County, where the population exceeds 750,000.

The network confusion only affects Anthem’s individual plans, called Pathways. The ACA is also known as Obamacare, and its exchange only sells individual plans. Anthem’s group or employer plans that had WellStar still have WellStar.

The incident recalls the turmoil faced this year by Anthem customers in Cobb, who signed up in the fall of 2018 for 2019 plans. At the time they signed up WellStar actually was in Anthem's individual network.

But in February, when 2019 policyholders were already locked in for the year, Anthem dropped WellStar from its individual network. WellStar said Anthem had told the health system months before what it planned to do. Patients told The Atlanta Journal-Constitution they didn’t learn of the change then from Anthem, but from medical offices when they went to book appointments.

The federal government then refused to issue a new window for WellStar customers or Cobb residents to switch plans away from Anthem.

Some of the policyholders sued Anthem.

That case is still pending. The patients’ lawyer, Jason Doss, said Tuesday that the new issue shows Anthem hasn’t fixed the problem.

“It’s crazy,” Doss said. “It’s like the Britney Spears song, ‘Whoops, I Did It Again.’”

He added that for customers who’ve already signed up, the damage is hard to walk back.

“Unfortunately, this notice is not going to do it,” he said. “There’s going to be victims that don’t switch out for a variety of reasons,” including that the news may not reach them.

Neither the state, Anthem nor the federal agency that runs the exchange, the Centers for Medicare and Medicaid Services, had a clear answer for how the inaccuracy could be allowed to display this year — and go on for over two weeks — after last year’s well-publicized damage from patients not knowing about the coming WellStar gap in the Anthem network.

The state emphasized that it doesn’t regulate the ACA marketplace exchange.

It was WellStar that alerted the Department of Insurance last week that Anthem had incorrectly advertised the health system as part of Anthem’s product.

In the 2018-2019 incident, the Department of Insurance stepped in and issued a compromise. Anthem agreed to consider most doctor visits as in network. Most hospital inpatient and outpatient services were never brought back in network. For many services on the HMO-like plans, that means that Anthem would not pay anything.

WellStar issued a written statement Tuesday emphasizing that Anthem group plans still had WellStar in network. And for individuals, it made sure customers knew Anthem’s competitors.

“We understand that Anthem is working to resolve this issue,” Barbara Corey, WellStar’s senior vice president of managed care, said in the statement. “To support patients affected by WellStar’s exclusion from the Pathway Network product, and help ensure that patients can continue to access WellStar’s high quality care, WellStar has three additional contracts with Health Insurance Exchange (HIE) insurers: Ambetter; CareSource and Oscar.”