Am I paying too much for my insurance? Whether you live in Cedar Hill, Mansfield, Benbrook, Saginaw, Keller, Fort Worth, Dallas, Grand Prairie, Arlington, or some other place in Texas, that would be a question most people would ask at one time or another when thinking about their finances.
For a California woman, the answer to the above question seems to be, yes. She has sued Blue Shield of California, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety net insurance for peole who were sick or jobless.
This was reported by the Los Angeles Times in an article written by Duke Hefland and published on July 8, 2010.
The title to the article is, “Blue Shield of California is accused of overcharging for safety-net insurance.”
A 64 year old lady by the name of Amalia Lample said in her lawsuit that Blue Shield, the state’s second largest not for profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.
Lample is argueing that she is owed $4,475 in excess charges she paid from 2007 to 2009. She also claims that more than 6,000 Blue Shield policyholders with similar coverage also were overcharged since 2001.
“This is for justice. It’s not only for the money,” said Lample, who decided to file her lawsuit in Los Angeles County Superior Court after reading a story in The Times about Blue Shield’s rates. “It’s not right what they do.”
The lawsuit seeks class- action status. There has been no comment from the San Francisco company.
Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.
On Wednesday a department spokeswoman said the law’s definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much. As a result, the department is sponsoring a bill in the Legislature to “eliminate any question” on rates insurers can charge.
At issue is health coverage available under the federal Health Insurance Portability and
Accountability Act (HIPAA). Insurers are required by the federal law to sell insurance to people who have lost their jobs or who would otherwise be ineligible because of preexisting medical conditions.
HIPAA policyholders maintain that Blue Shield and one of its chief competitors, Anthem Blue Cross, have substantially overcharged subscribers for several years. Blue Shield says that its HIPAA rates comply with state guidelines.
Anthem, on the other hand, determined that it had overcharged customers between 2006 and 2009, and agreed to issue refunds.
As it relates to Anthem, one policyholder, Culver City attorney Les Greenberg, accused Anthem of returning only a fraction of what was due. Anthem had given Greenberg a $12 refund. He took the company to Small Claims Court. A judge agreed with Greenberg in September, awarding Greenberg with more than $7,300.
Greenberg filed another lawsuit in December on behalf of another Anthem subscriber, saying the insurer owed additional refunds to more than 10,000 HIPPA policyholders. Anthem issued a statement Wednesday saying its refunds were “appropriate.”
Greenberg is also representing Lample in the lawsuit filed against Blue Shield.
“They have gone off on a lark of their own to overcharge their subscribers,” Greenberg said of the two insurers. “I would call it egregious behavior.”
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