Centene sued over Ambetter plans in 26 states – Crain's Chicago Business

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Consumers of health insurance plans offered by St. Louis-based health insurance giant Centene, and its Chicago-based subsidiary, Celtic Insurance, have filed a class-action complaint against the companies, alleging they didn’t provide the advertised benefits.
The lawsuit, filed in the U.S. District Court for the Eastern Division of the Northern District of Illinois on Friday, alleges that Centene, through its subsidiaries, sold “fraudulent health insurance policies” to millions of consumers across 26 states, including Illinois, since 2013. Read the complaint below.
The primary issue consumers raise in the complaint is that many members of Ambetter, Centene’s consumer-facing insurance plans, have difficulty finding an in-network provider and, in some cases, have been unable to find any provider that takes Ambetter plans.
As a result, some Ambetter members have suffered delays in treatment, been unable to find treatment, been forced to travel hundreds of miles to in-network providers and pay out-of-pocket fees. The complaint also alleges that Ambetter plans refuse to pay for some services they advertised covering.
The suit alleges that Centene’s Ambetter plans were overcharging consumers by “hundreds of millions of dollars a year” because they weren’t offering the advertised benefits. The lawsuit also says that the plans failed to abide by the minimum requirements set by the Affordable Care Act and other federal and state laws.
Centene is the largest provider of Medicaid managed-care health plans that are available on the ACA exchanges, according to Centene’s website. More than 2 million people currently pay for Ambetter plans, according to the complaint. Two of the people listed in the complaint hail from Illinois. Others live in Florida, St. Louis and Texas. Plaintiffs are being represented by attorneys from Chicago-based Wexler Boley & Elgersma.
The proposed class includes up to 10 million people who were Ambetter members from August 2018 to date. The plaintiffs are looking to recover what they consider overcharges.
Centene denies the allegations.
“Beginning with passage of the ACA in 2010, Centene and its local subsidiaries have worked successfully with regulatory partners to help members and their families gain access to comprehensive, affordable and high-quality marketplace health plans,” Centene said in a statement to Crain’s. “This lawsuit is merely one more attack on the Health Insurance Marketplace and the ACA itself. Centene will fight this lawsuit vigorously and will continue to uphold the important purpose of the ACA to improve the health of our communities, one person at a time.”
Centene projects 2022 revenue of more than $142 billion and employs more than 82,000 people nationwide, according to its website.
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