Plaintiffs are a class of people who were enrolled in Preferred Provider Organization (“PPO”) health insurance offered and/or administered by the California Public Employees’ Retirement System and its Board of Administration (collectively “CalPERS”) and Anthem Blue Cross Life & Health Insurance Company (“Anthem” or “Anthem Blue Cross”).
Between 2006 and 2014, CalPERS and/or Anthem engaged in a common policy or practice of improperly and artificially reducing the “Allowable Amount” for “out-of-network” non-emergency medical services.
By artificially reducing the “Allowable Amount,” CalPERS and/or Anthem caused reimbursements for “out-of-network” medical expenses to be substantially below prevailing standards, including below the “usual, customary, and reasonable” (UCR) standards.
Plaintiffs and the class presented their claims and received reimbursement from Anthem and/or CalPERS for “out-of-network” non-emergency medical expenses, but Anthem and/or CalPERS reimbursed each person less than required under contract, industry standard, statute, or law.
In addition, CalPERS and/or Anthem hid the improper policy and practice of artificially reducing the “Allowable Amounts” for “out-of-network” non-emergency expenses and the resulting reduced reimbursements, which was only recently discovered.