Anthem/Elevance Health: A Pattern of Patient Neglect

From 2015 to 2018, Anthem suffered a massive data breach that compromised the personal information of 78.8 million individuals. This breach exposed sensitive data, including Social Security numbers and medical records, highlighting Anthem’s inadequate cybersecurity measures.

The breach led to a historic $115 million settlement, the largest consumer data breach settlement in U.S. history at the time. Victims were offered credit monitoring, fraud protection, and reimbursement for out-of-pocket losses.

Anthem failed to protect millions of Americans' private information, prioritizing profits over security.

In 2015, Anthem proposed a $54 billion merger with Cigna, aiming to consolidate their market presence. However, due to significant antitrust concerns, the U.S. government intervened.

By 2017, courts blocked the merger, citing that it would reduce competition by decreasing the number of national insurers from five to four. Judge Amy Berman Jackson dismissed Anthem’s claims of cost savings as unverifiable and not specific to the merger.

Anthem's aggressive expansion efforts were thwarted, leaving the market less competitive and consumers with fewer choices.

In 2017, Anthem introduced a policy that retroactively denied coverage for emergency room visits deemed "non-emergencies." This controversial move sparked widespread backlash and legal challenges.

By July 2018, physician groups filed lawsuits against Anthem, arguing that the policy violated the federal "prudent layperson standard." This standard mandates coverage decisions based on a patient's symptoms rather than final diagnoses.

Anthem's policy not only left patients with hefty bills but also discouraged them from seeking necessary emergency care, disproportionately affecting vulnerable populations.

In September 2021, Owens & Minor filed a lawsuit against Anthem, accusing the insurer of mismanaging its self-funded health plan and withholding critical claims data. This lawsuit has expanded and remains ongoing as of November 2024.

Owens alleged that Anthem engaged in a two-year "game of hide the ball," refusing to release necessary claims data required under ERISA standards. Investigations revealed that Anthem overpaid claims, secured kickbacks from providers, and withheld rebates owed to plan participants. Additionally, the BlueCard program was criticized for inflating costs through hidden fees, further diminishing transparency.

Anthem's obstruction of transparency and financial mismanagement undermined the integrity of the health plan, harming both employers and employees.

In October 2024, a class-action lawsuit was filed against Anthem, accusing the company of maintaining "ghost networks." These inaccurate provider directories misled patients about the availability of in-network care.

A secret shopper study revealed that only seven out of 100 listed providers actually accepted Anthem insurance or were taking new patients. This deceptive practice forced patients seeking mental health care to face delays or abandon treatment, resulting in significant financial burdens from unexpected out-of-network costs.

Anthem's misleading directories violated consumer protection laws, causing widespread harm and eroding trust in their network services.

In 2024, California’s Department of Managed Health Care (DMHC) imposed an $8.5 million fine on Anthem for its persistent failures to resolve claims payment disputes with providers and policyholders within the mandated timeframes.

These fines were issued in September and November 2024, with ongoing violations documented since the early 2000s. Anthem's delayed payments have caused financial instability for healthcare providers, disrupting patient care and services.

Anthem's systemic negligence in handling claims payments has led to significant financial penalties and undermined trust with both providers and policyholders.

In 2024, Anthem faced a class-action lawsuit alleging wrongful denials of coverage for microprocessor-controlled prosthetic limbs. The company was accused of using unreasonably strict criteria to reject claims for these essential devices.

Plaintiffs argued that Anthem's denial criteria failed to consider the prosthetics' ability to significantly improve quality of life beyond mere walking speed. The settlement in August 2024 provided compensation for denied claims and mandated policy changes to ensure fair coverage.

Anthem's discriminatory denial practices impeded individuals with disabilities from accessing vital mobility aids, exacerbating their challenges.

During the litigation from September 2021 to November 2024, Owens & Minor also targeted Anthem's BlueCard program, alleging that it inflated healthcare costs through hidden fees and a lack of transparency.

The allegations stated that BlueCard fees were retained by Blue Cross affiliates without proper disclosure to plan sponsors. These hidden fees contributed to inflated healthcare costs for both employers and employees. The Federal Trade Commission has been scrutinizing similar practices across the insurance industry, adding pressure on Anthem to reform its billing practices.

Anthem's deceptive billing practices within the BlueCard program undermined trust and inflated costs, exploiting both employers and employees.

Anthem has a long history of failing to address grievances within the legally mandated timeframes. From the early 2000s through November 2024, the company has been repeatedly fined for these systemic issues.

In August 2024, the DMHC fined Anthem $162,000 for not providing clear grievance resolutions promptly. Previous fines include a $5 million penalty for similar violations between December 2013 and August. These delays have left policyholders without timely responses during critical healthcare disputes.

Anthem's persistent negligence in grievance resolution has disrupted patient care and eroded trust with its members.

The failed merger between Anthem and Cigna in 2017 underscored Anthem's anticompetitive practices. The Department of Justice (DOJ) and courts concluded that the merger would decrease competition, reducing the number of national insurers and potentially leading to higher premiums for consumers.

Judge Amy Berman Jackson rejected Anthem's claims that cost savings from the merger would mitigate its anticompetitive effects. The increased market concentration raised concerns across multiple states where both companies operated, highlighting the broader implications for the national insurance market.

Anthem's aggressive expansion strategies threatened market competition, disadvantaging consumers through reduced choices and higher costs.