San Diego Sues Kaiser Insurers for False In-Network Provider Directories – Courthouse News Service

The city’s lawsuit claims the companies’ health provider directories were false or inaccurate and confused consumers seeking in-network care.

KaiserPermanenteBldg
A Kaiser Permanente building near its headquarters in Oakland, Calif. (Coolcaesar via Wikipedia)

SAN DIEGO (CN) — San Diego City Attorney Mara Elliott filed lawsuits Thursday against three California health insurance providers accused of deceiving consumers by publishing false or misleading health provider directories.

The lawsuits filed in San Diego Superior Court claim the health insurers publish directories listing doctors and other providers not covered by consumers’ plans.  

State and federal laws require insurers to post accurate directories of in-network care providers for consumers, many of whom evaluate provider listings when deciding which insurer to enroll with.

The insurers named in the complaints — Kaiser Foundation Health Plan, Molina Healthcare of California and HealthNet — have failed to follow the law, the lawsuits said.

“These false listings create formidable, dangerous, and unlawful barriers to patient care, harming public health and California health insurance markets,” attorneys for San Diego wrote in the complaints. “These inaccurate directories, known as ‘ghost networks,’ falsely describe the breadth of an insurer’s provider network, promising consumers access to health care that in reality is unavailable under the plan.”

The false or inaccurate listings have left countless consumers frustrated at the fruitless search for care or weighed down with out-of-network provider costs.

The defendant insurers’ actions have also forced consumers to delay medical care or skip a health procedure entirely due to the false information in the provider directories, the lawsuits said.

City attorneys allege Kaiser and HealthNet directories have inaccuracy rates of at least 35% while Molina’s provider directories may be as high as 80% false or incomplete. 

Kaiser, which has over 9 million Californians enrolled in health plans, has an overall inaccuracy rate of 19% and one of the worst rates for mental health listings with 32% of psychiatrists on the directory being false or inaccurate listings.

An unnamed Molina plan enrollee identified in the complaint said in a letter to the Better Business Bureau this March she’s been left frustrated after searching for care on the inaccurate directories.

“I have called dozens of providers from Molina’s website. I even opened it up to ‘within 50 miles’ of my zipcode,” the enrollee wrote in the letter. “Every single receptionist who has answered says that they DO NOT ACCEPT Molina insurance. The website says it was updated yesterday, but when I ask these providers if they ever took Molina, most of them say they have not taken it for 3 or more years.. . . I may as well have not even bought insurance.”

Defendant insurers may be unlawfully reaping financial gains based on enrollment of consumers who believe their health plans offer them access to an expansive provider network, the lawsuits said.

The complaints allege false advertising and unlawful business practices.

Elliot said in a statement Friday the inaccurate provider directories are a danger to both consumers and the public health system.

“Consumers should be able to trust their health insurers when seeking medical attention,” Elliott said. “Error-filled directories create dangerous barriers to healthcare services, with patients struggling to find a directory-listed doctor who will accept their insurance. These misleading ghost networks not only violate state law but undermine the health of San Diegans and Californians.”

Representatives for the defendant insurers did not immediately respond to requests for comment on the respective lawsuits. 

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