A new class action lawsuit has accused the parent company of health insurer Blue Cross Blue Shield of breaching its contract and violating Illinois’ consumer fraud laws because the insurer allegedly refuses to cover out of network care at the levels it leads its customers to believe when they purchase plans.
Last month, attorneys with the firm of Jaszczuk P.C., of Chicago, filed suit in Cook County Circuit Cout against Chicago-based Health Care Service Corporation, which does business as Blue Cross Blue Shield of Illinois.
Calling it a “classic bait-and-switch,” the class action lawsuit alleges Blue Cross allegedly assures policy holders will receive certain levels of benefits – particularly, 50% coverage for treatment and medical services received through out-of-network providers – but allegedly covers substantially less, while allegedly providing benefits statements and other documents that leave policy holders confused and owing more than allegedly should.
“The end result is that policyholders are left confused, worn-down, indebted, defeated, and ultimately discouraged from seeking non-emergency treatment,” the complaint said.
The complaint was filed on behalf of named plaintiff Aleksandra Zieba, identified only as a resident of Illinois.
The complaint detailed Zieba’s account of her alleged interactions with HCSC as a Blue Cross Blue Shield policy holder for treatment of allegedly debilitating chronic conditions caused by Lyme disease. According to the complaint, Zieba sought various treatments from various clinicians for nearly two decades, before seeking treatment from a facility that specialized in treating the illness.
The treatments were ultimately successful at providing relief.
However, after purchasing a plan through Blue Cross that she believed would provide the coverage needed, Zieba asserts months of wrangling allegedly followed, ultimately allegedly resulting in her and her husband owing tens of thousands of dollars for her treatment.
The complaint seeks to expand the legal action to include an unspecified number of other Illinoisans who may fall within five classes of additional plaintiffs.
These would include:
Illinois BCBS customers who, in the past three years, received less than 50% coverage for care received through out-of-network providers, after deductibles were applied;
Illinois BCBS customers who, in the last three years, received so-called Explanation of Benefits forms which “did not match the claim the policyholder submitted or contained undated line-item entries,” or which “contained statements about savings negotiated with out-of-network providers;”
Illinois BCBS customers who, in the last three years, “never received a final determination on any portion of the submitted claim;” and
Illinois BCBS customers who, in the last three years, “received no response or a false response,” when seeking to learn whether a proposed treatment would be covered, before receiving the treatment.
The complaint accuses HCSC and BCBS of Illinois of breach of contract, bad faith and violations of the Illinois Consumer Fraud and Deceptive Business Practices Act and the Illinois Deceptive Trade Practices Act.
The plaintiffs are seeking unspecified actual damages, punitive damages and attorney fees, among other damages.