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Centene Misled Customers on Obamacare Coverage, Lawsuit Claims

Bloomberg 2018-01-11 19:56:02

Centene Corp. misled customers about the number of doctors covered under its health plans, offering individuals who bought Obamacare plans far skimpier coverage than they signed up for, according to a lawsuit filed on Thursday.

Customers in Centene’s Affordable Care Act insurance plans had difficulty finding care providers who’d accept their insurance, and found that even doctors listed by the insurer as taking the coverage often didn’t, according to the federal suit filed in Washington State on Thursday. 

The suit filed on behalf of two customers seeks class-action status to represent all customers of Centene’s Obamacare plans, which are sold under the Ambetter brand.

From Businessweek: How Centene is Making a Fortune on Obamacare

“Members have difficulty finding -- and in many cases cannot find -- medical providers who will accept Ambetter insurance,” according to the lawsuit. “After purchasing an Ambetter insurance plan, they learn that the provider network Centene represented was available to Ambetter policyholders was in material measure, if not largely, fictitious.”

Centene, which specializes in covering low-income individuals, has been expanding in the Affordable Care Act’s marketplaces even as rivals retreat. The company, based in St. Louis, now has more than 1.4 million customers in its ACA plans across 15 states, placing it among the largest health insurers in the program.

Centene Chief Executive Officer Michael Neidorff built up the insurer by covering poor, disabled and pregnant individuals in state Medicaid programs. The company has used many of the skills and strategies developed in that program in its ACA plans, including limiting where its members can get care to hospitals and doctors willing to accept lower reimbursement rates.

The scrutiny of the company’s provider networks could limit its expansion plans or reduce profits. Washington State’s insurance regulator briefly forced Centene to halt sales late last year after finding the company failed to include enough care providers in its network. The insurer has to fix the problem and submit to outside monitoring. Centene is also seeking to expand into New York by acquiring the health insurer Fidelis Care.

The case is Harvey v. Centene Corp., 18-cv-00012, U.S. District Court, Eastern District of Washington (Spokane).

— With assistance by Andrew M Harris