Class Action Lawsuit is Filed Against Blue Shield of California
By Scott Glovsky on September 18th, 2018 in Class Action, Insurance Bad Faith
A class action lawsuit has been filed against Blue Shield of California by Ashley Summers, a California resident who had been with Blue Shield for years. In the lawsuit, Ashley claims Blue Shield canceled her coverage without warning and rendered her unable to get the prescriptions or see the specialists she needs for her fibromyalgia and rheumatoid arthritis.
For years, Ashley Summers relied on Blue Shield’s coverage to manage her health. She paid her premiums on time every month and only saw physicians in the Blue Shield network. In February 2018, she went to the pharmacy for a regular refill, only to be told that Blue Shield had canceled her coverage.
When Ashley called Blue Shield to ask why they had canceled her coverage, they said it was due to delinquent payments. However, Ashley knew she had been paying them on time every month through her bank. Blue Shield also did not give Ashley any notice before canceling her policy, although insurance companies are required by law to provide advanced written notice.
Blue Shield told Ashley they would reinstate her plan if she made an additional payment. Needing the coverage, Ashley did so. On March 4, 2018, Ashley then received a letter from the insurance company telling her they were canceling her policy “upon her request.” Ashley never requested a cancelation and in fact, recently fought to keep the policy by making an additional payment. But it was too late – the policy had already been canceled, again without proper notice.
On April 25, 2018, Ashley sent a grievance to Blue Shield, asking them to reinstate her plan. They denied her reinstatement, citing the alleged delinquent payment from February of that same year.
In May 2018, Ashley contacted the Department of Managed Health Care (DMHC), an agency that regulates the type of healthcare plan Ashley was on with Blue Shield. The DMHC then sent a complaint to Blue Shield.
Soon after Blue Shield received the complaint from DMHC, they told Ashley they would reinstate her plan if she paid $2,381.30 in premiums for the four months during which she did not even receive benefits and for one future month.
Ashley simply could not afford that payment. Without insurance for the past four months, she had paid out of pocket for costly medications required to treat her condition. She was also unable to see the specialists that helped with her conditions, causing her to suffer physical injury and emotional distress. Without the money for the reinstatement payment, she was still left without insurance.
Ashley is now filing a lawsuit against Blue Shield of California for herself and a putative class, which, legally, is the class of similarly situated people that have been injured by Blue Shield in the same way.
Unfortunately, this is not the first time Blue Shield of California has faced such a lawsuit. In May 2018, the organization agreed to pay seven million dollars to settle another class action lawsuit. In this case, they were accused of imposing improper restrictions on individuals seeking coverage for mental health treatments.
In 2014, a class action lawsuit accused the insurance company of denying coverage to individuals that did not use a physician or health care provider within their network. These individuals had used physicians listed as being in-network on Blue Shield’s website.
It is important for individuals seeking coverage to understand that when they have been treated unfairly by an insurance company, they do not have to be at their mercy. If an insurance company has put your health and finances at risk, contact an attorney to begin fighting for your legal rights.