WellPoint, Inc., Blue Cross Blue Shield, Anthem, and Other Health Insurers, Short Changed Policy Holders Using Fraudulent Reimbursement Methodologies, Says New York Attorney General

In 2009, the Office of the Attorney General of the State of New York (OAG), found that insurance companies, including WellPoint Inc., and its subsidiaries and affiliates, systematically shortchanged health insurance customers by under reimbursing for out-of-network medical services by up to 28%. In a report, the OAG concluded that “[t]he current industry model for reimbursing out-of-network care is fraudulent.”

Among other things, the OAG found that the description of out-of-network coverage was confusing, making it difficult for policyholders to understand how their out-of-network benefits would be calculated ahead of time, and, according to the OAG, the “explanation of benefits” provided after payment was made was similarly confusing and overly complicated.

The OAG reached a settlement with several insurance companies, which agreed to discontinue the underpayments and institute a new system for calculating reimbursement for out-of-network claims, and to make the calculation of benefits more transparent and easier to understand.

As part of its settlement with the OAG, WellPoint agreed to pay $10 million to fund the reforms demanded by the OAG, including the creation of a new database that would be used to determine out-of-network reimbursements.

Despite the settlement with the OAG, however, WellPoint’s levels of reimbursements appear to be even lower today than they were prior to the OAG’s action.

WellPoint subsidiaries and affiliates include:

Anthem Benefit Administrators, Inc.	HealthKeepers, Inc.
AHI Healthcare Corporation	HealthLink, Inc.
American Imaging Management, Inc.	HealthLink HMO, Inc.
American Imaging Management East, LLC	HealthReach Services, Inc.
Anthem Blue Cross and Blue Shield Plan Admin, LLC	Healthy Alliance Life Insurance Company
Anthem Blue Cross Blue Shield Partnership Plan	HMO Colorado, Inc.
Anthem Blue Cross Life and Health Insurance Co.	HMO Missouri, Inc.
Anthem Credentialing Services, Inc.	Imaging Management Holdings
Anthem East, Inc.	Imaging Providers of Texas
Anthem Financial, Inc.	IMASIS LLC
Anthem Health Insurance Company of Nevada	Landmark Solutions, LLC
Anthem Health Plans of Kentucky, Inc.	Lease Partners, Inc.
Anthem Health Plans of Maine, Inc.	Lumenos, Inc.
Anthem Health Plans of New Hampshire, Inc.	Machigonne, Inc.
Anthem Health Plans of Virginia, Inc.	Matthew Thornton Health Plan, Inc.
Anthem Health Plans, Inc.	Meridian Resource Company LLC
Anthem HMO of Nevada	National Capital Preferred Provider Org, Inc.
Anthem Holding Corp.	National Government Services Inc.
Anthem Insurance Companies, Inc.	OneNation Insurance Company
Anthem Life & Disability Insurance Company	Park Square Holdings, Inc.
Anthem Life Insurance Company	Park Square I, Inc.
Anthem Southeast, Inc.	Park Square II, Inc.
Anthem UM Services, Inc.	Peninsula Health Care, Inc.
Anthem Workers’ Compensation, LLC	Plan of Georgia, Inc.
Arcus Enterprises, Inc.	Priority Health Care, Inc.
ARCUS Financial Services, Inc.	R&P Realty Inc
ARCUS Healthy Living Services, Inc.	Radiant Company LLC
Associated Group, Inc.	Resolution Health, Inc
ATH Holding Company, LLC	RightChoice Insurance Company
Behavioral Health Network, Inc.	RightCHOICE Managed Care, Inc.
Blue Cross and Blue Shield of Georgia, Inc.	Rocky Mountain Hospital and Medical Services, Inc.
Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	SellCore Inc
Blue Cross Blue Shield of Wisconsin	Southeast Services Inc
Blue Cross of California	Summit Admnistrative Services LLC
Blue Cross of California Partnership Plan, Inc.	The Wellpoint Companies, Inc.
Cerulean Companies, Inc.	Trust Solutions LLC
Claim Management Services, Inc.	UNICARE Health Insurance Company of Texas
Community Connect Health Plan of Pennsylvania, Inc.	UNICARE Health Insurance Company of the Midwest
Community Insurance Company	UNICARE Health Plan of Kansas, Inc.
Compcare Health Services Insurance Corporation	UNICARE Health Plan of West Virginia, Inc.
Crossroads Acquisition Corp	UNICARE Health Plans of Texas, Inc.
DeCare Analytics, LLC	UNICARE Health Plans of the Midwest, Inc.
DeCare Dental Health International, LLC	UNICARE Life & Health Insurance Company
DeCare Dental Insurance Ireland, Ltd	UNICARE National Services, Inc.
DeCare Dental LLC	UNICARE of Texas Health Plans, Inc.
DeCare Dental Networks LLC	UNICARE Illinois Services, Inc.
DeCare Operations Ireland Limited	UNICARE Specialty Services Inc
DeCare Systems Ireland, Limited	United Government Services LLC
Dental Claims Administrative Services, Inc.	UtiliMED IPA Inc
Designated Agent Company	WellChoice Insurance of New Jersey, Inc.
EHC Benefits Agency	WellPoint Acquisition, LLC
Empire HealthChoice Assurance, Inc.	WellPoint Behavioral Health, Inc.
Empire HealthChoice HMO, Inc.	WellPoint California Services, Inc.
Etico LLC	WellPoint Dental Services, Inc.
Forty Four Forty Four Forest Park Redevelopment Corp.	WellPoint Holding Corp
Golden West Health Plan, Inc.	WellPoint Inc.
Government Health Services, LLC	WellPoint Insurance Services, Inc.
Health Core, Inc.	WellPoint Partnership Plan LLC
Health Management Corp	WPMI LLC
Health Ventures Partner, LLC	WPMI Ltd

If you have, or had, health insurance through WellPoint or any of WellPoint’s subsidiaries and affiliates, and would like to receive more information, please fill out the form on the right or contact the following attorneys:

Andrei Rado, Esq.
Jennifer Sosa, Esq.
Milberg LLP
One Pennsylvania Plaza, 49th Fl.
New York, NY 10119
(800) 320-5081

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