Woman Sues Insurer, Accuses Obamacare Doctor Network

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A Kansas woman is suing Blue Cross and Blue Shield of Kansas City, alleging that the insurer misled customers on what physicians were covered in its Obamacare health plans.

Debra Simon filed a class action lawsuit in Kansas’s Jackson County District Court against the company, in which she claims that the list of doctors covered in the Obamacare plan she bought was incorrect.

Simon alleges that the website indicated that several specific doctors were covered by the Obamacare exchange health plan, but when she and her family actually saw the physicians she was billed for out-of-network care later on, the Kansas City Business Journal reports.

“Blue Cross’s practices were at best deceptive and unfair, and at worst constituted a deliberate ‘bait and switch’ aimed at attracting greater amounts of customers and insurance revenues,” Simon claimed in the petition.

Simon is not the first customer to have trouble figuring out just what care is covered in Obamacare exchange plans. California’s Obamacare exchange posted a faulty physician directory on its website twice, causing customers to be turned away by doctors that the exchange had promised were covered on the plans.

Covered California, the state’s exchange, first pulled the directory in October over incorrect data and replaced it with an updated version which customers again found to be error-ridden in February. It’s now abandoned its goal to provide a physician directory. (RELATED: California Obamacare Exchange Pulls Incorrect Doctor Directory After Patient Outcry) 

A key problem insurers are facing is in-flux networks. Doctors can, and do, pull out of provider networks outside of the Obamacare open enrollment period, when customers can’t replace their coverage with a different Obamacare plan that does include their doctor.

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