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Commonly Asked Questions


1. Why was a notice issued?

Answer:

The Court authorized a notice because you had a right to know about a proposed settlement in four lawsuits against Anthem and all of your options, before the Court decided whether to give final approval to the settlement. The notice told you: (1) about the terms of a proposed settlement, including the available benefits, (2) how the lawsuits and the settlement affect your legal rights, and (3) how to object or exclude yourself if you did not like the settlement.

The four lawsuits have been coordinated into one proceeding, Anthem Blue Cross Affordable Care Act Cases, Judicial Council Proceeding No. 4805 (“the Lawsuits”). Judge Elihu M. Berle of the Superior Court of the State of California for the County of Los Angeles is overseeing the Lawsuits. The people who sued are called the “Plaintiffs.” Anthem is the “Defendant.”

2. What are the Lawsuits about?

Answer:

During the Affordable Care Act’s (“ACA”) first designated enrollment period between October 1, 2013 and March 31, 2014 (“2014 Open Enrollment Period”), Anthem offered new ACA-compliant individual and family Preferred Provider Organization (“PPO”) and Exclusive Provider Organization (“EPO”) plans to consumers for sale through and outside of the Covered California health insurance exchange. The Lawsuits claim that Anthem misrepresented that specific physicians and hospitals were available under the ACA- compliant health service plans when they were not, and concealed and failed to disclose that the new ACA plans were limited to a much narrower provider network than other plans. The Lawsuits also allege that Anthem sent incorrect ID cards, or failed to send ID cards, to members.

Anthem denies any wrongdoing related to the claims in the Lawsuits.

3. How long do I have to cash my settlement check? 

Answer:

Class Members have 120 calendar days after their settlement check is mailed, or by April 6, 2017, to cash their settlement checks.

If you need a check reissue for any reason, your reissue request must be received by the Settlement Administrator on or before April 6, 2017. To request a reissue, please mail your request, with the voided check to: Felser Settlement Administrator, P.O. Box 2509, Faribault, MN 55021-9509. 

4. What happens if I lose or damage my settlement check?

Answer:

Class Members who have lost or damaged a settlement check can request in writing that a new check be issued by contacting the Settlement Administrator at the address below. You must request a replacement check within 120 calendar days of the date of the original settlement check, or by April 6, 2017. Do not call or write Anthem or Anthem’s lawyers for information or advice about this lawsuit.

Felser Settlement Administrator
P.O. Box 2508
Faribault, MN 55021-9508

1-866-384-9362

5. When would I get my payment (if I qualify)?

Answer:

The Court held a Final Fairness hearing on August 12, 2016 at 9:00 a.m. to decide whether to approve the settlement. The Court approved the settlement. Automatic Payments were mailed on December 7, 2016.

For those Class Members who submitted Claim Forms, all timely claim forms have been received and are being reviewed by the Settlement Administrator. Please be patient as this process takes time. 

6. Why is this a class action?

Answer:

In a class action, people called Class Representatives sue on behalf of other people who have similar claims, called the Class or Class Members. The Class Representatives in this case are Plaintiffs Samantha Berryessa Cowart,  Lesley  Noble,  Betsy  Felser,  Patricia  Griffin,  Felicia  Moghadam, Steven  Moore,  Josh  Worth, Deborah Nitasaka, J. Christian Conrad and Mendy Lynn Conrad. In a class action, one court resolves the claims for all Class Members, except for people who want to exclude themselves (“opt-out”) from the Class.

7. Why is there a settlement?

Answer:

The Court did not decide in favor of Plaintiffs or Anthem. Instead, the Parties have entered into a Settlement Agreement.  Settling saves the time, expense, and uncertainty of litigation.  It also provides Class Members immediate relief, rather than waiting for possible relief years from now, or possibly receiving nothing.

8. How do I know if I am part of the settlement?

Answer:

You were included in the settlement and could have potentially gotten payment under the settlement if you were enrolled in an Anthem individual PPO or EPO health plan in 2014. The settlement only applies to 2014 health plans purchased by individuals and families, not employer-provided health plans. The settlement does not apply to grandfathered health plans.

 
Excluded from the Class are (i) any judicial officer presiding over the Lawsuits and the members of his/her immediate family and judicial staff; (ii) any person who has entered into a written settlement agreement with Anthem with respect to an Anthem individual PPO or EPO health plans, which releases the same claims released under the Settlement Agreement; and (iii) any person who timely opts-out of the Class.

9. What does this settlement provide?

Answer:

Anthem has agreed to reimburse Class Members who paid more out-of-pocket because they received medical services from an out-of-network professional. Class Members had the opportunity to recover 100% of the out-of-pocket expenses for medical services rendered by an out-of-network professional in 2014.

Automatic Payment: If Anthem has a record of Class Members’ out-of-network medical services, Anthem sent checks directly to Class Members with no claims process required:

Class Members enrolled in an EPO plan received a payment equal to 70% of the “billed charges” submitted to Anthem by the medical professional or Class Member. For EPO members, the settlement covers charges incurred in 2014 for services from any out-of-network professional.

Class Members enrolled in a PPO plan received a payment equal to 50% of the “billed charges” submitted to Anthem for services provided by any medical professional potentially misrepresented as participating in an ACA PPO health plan. For PPO members, the settlement covers charges incurred in 2014 for services from any medical professionals who were listed as in-network in any Anthem ACA  PPO  plan  but  who  were  not  participating in-network  at  the  time medical services  were provided.

Notably, EPO members have no plan benefits for treatment with out-of-network doctors.  By contrast, PPO members have some benefits for treatment with out-of-network doctors. Accordingly, the settlement percentage for EPO members is higher than it is for PPO members. Once Class Members received their settlement check, they could submit additional records supporting a larger reimbursement if they paid more for the out-of-network services.

In the aggregate, Anthem automatically sent checks to impacted Class Members totaling Fourteen Million, Nine Hundred Fifty Nine Thousand, Four Hundred Thirty Five Dollars and Zero Cents ($14,959,435.00).

This payment approximates Class Members’ actual out-of-pocket expenses. Although Anthem is aware of some of the out-of-network services rendered to Class Members, Anthem does not have records reflecting how much Class Members actually paid for those services.

Claims: If neither Class Members nor their doctor previously submitted claims to Anthem for their out-of-network medical services, they must have submitted a Claim Form to receive a payment. Once the settlement was approved by the Court, Anthem mailed a claim form to Class Members who did not submit records to Anthem of out-of-network services. They then had 30 days to complete and return the claim form to the address provided in order to get a payment. The fund available to pay for these out-of-network claims for which Anthem does not have a record is uncapped.
 
Class Members may have submitted Claims for out-of-network services they already paid for, and those subject to active collection efforts at any time in the 90 days prior to the initial hearing on preliminary - between November 20, 2015 and February 19, 2016.

The Parties agreed to these payments and the Court has approved them.

Anthem also has agreed to undertake measures to improve: member, provider, and broker understanding about ACA-compliant plans, access to in-network providers, and accuracy of provider lists. Going forward, Anthem will treat a provider as in-network for billing purposes if a provider is listed in-network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services.

10. What do I need to do to receive a payment I am due?

Answer:

If Anthem had a record of your out-of-network medical services, you automatically received a check:  If you received medical services in 2014 from an out-of-network medical professional and you or your medical professional previously submitted records to Anthem, you did not have to do anything to receive a payment. Once the Court approved the settlement, you automatically received a check for:

• 70% of the “billed charges” submitted to Anthem, if you were in an EPO plan. For EPO members, the settlement covers charges incurred in 2014 for services from any out-of- network provider.

• 50% of the “billed charges” submitted to Anthem, if you were in a PPO plan for services provided by any medical professional misrepresented as participating in an ACA health plan. For PPO members, the settlement covers charges incurred in 2014 for services from any medical professionals who were listed as in-network in any Anthem ACA PPO plan but who were not participating in-network at the time medical services were provided.

If the amount of the reimbursement check did not fully reimburse you, you were able to submit a claim form for additional amounts. Once the Court approved the settlement, Anthem mailed you the reimbursement check along with a “Claim Form for Out-of-Pocket Expenses in Excess of Settlement Payment.” You must have submitted the Claim Form for Out-of-Pocket Expenses in Excess of Settlement Payment by January 6, 2017. The deadline to submit a Claim Form has now passed.

If Anthem did not have a record of your out-of-network medical services, you received a claim form that you MUST have submitted to recover: If you received medical services in 2014 from an out-of-network professional and you or the medical professional did not submit records to Anthem, you must have submitted a Claim Form to get a payment. Once the Court approved the settlement, Anthem mailed you a “Claim Form for Previously Unsubmitted Out-of-Network Professional Services.” You must have submitted the Claim Form for Previously Unsubmitted Out-of-Network Professional Services by January 6, 2017 in order to get a payment. The deadline to submit a Claim Form has now passed.

How do I know if Anthem had a record of my out-of-network medical services? If you or your provider submitted a record of out-of-network medical services to Anthem, you would have received an “Explanation of Benefits” by mail showing that Anthem received and processed the claim. You can also check your Anthem account online to see if Anthem has a record of your out-of-network claim. Anthem automatically sent you a check if it has a record of your out-of-network service. If you only received a claim form from Anthem, that means Anthem did not have a record of your out-of-network service.

11. Do all Class Members get a payment?

Answer:

No. Class Members who did not receive services from an out-of-network professional in 2014 or who did not pay more out-of-pocket because they received medical services from an out-of-network professional in 2014 will not receive a settlement check.

All Class Members and other California consumers will benefit from Anthem’s agreement to treat a provider as in-network in the future for billing purposes where a provider is listed as in-network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services.  Anthem also has agreed to undertake other measures to improve: the size of the ACA-compliant plans’ provider network; member, provider, and broker understanding about ACA-compliant plans; and accuracy of provider lists. As a result, all Class Members cannot sue, continue to sue, or be part of any other lawsuit against Anthem about the legal issues in this lawsuit. See Q. 15 below.

12. What happens if I don’t cash my settlement check?

Answer:

Settlement checks that are not cashed within 120 days after mailing of the initial check (or 60 days after mailing of a replacement check) will be void and a stop payment will be placed on the checks.  If you do not cash your check, you waive any right to any portion of the settlement and you will be bound by the Settlement Agreement.

Any uncashed settlement checks will be donated to St. Jude Children’s Research Hospital. In no circumstance will any of the Settlement Funds be retained by, or revert to, Anthem.

13. What will happen in the future if a provider is listed as in-network but is later treated as out-of- network by Anthem?

Answer:

As part of the settlement, Anthem agrees to treat any provider as in-network for billing purposes if that provider is listed as in-network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services.

14. Who benefits from Anthem’s agreement to treat providers listed as in-network as in-network for billing purposes in the future?

Answer:

All consumers who are enrolled in a California Anthem health plan, or who enroll in one in the future, will benefit from Anthem’s agreement to treat any provider as in-network for billing purposes if that provider is listed as in-network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services.

15. What am I giving up to get a payment or stay in the Class?

Answer:

Unless you excluded yourself, you are included in the Settlement Class.  That means that you cannot sue, continue to sue, or be part of any other lawsuit against Anthem relating to the legal issues in the Lawsuits and you cannot seek a recovery for any damages based on these claims other than the cost of the out-of- network treatment as defined above and in the Settlement Agreement (such as for personal injuries or emotional distress). It also means that all of the Court’s orders will apply to you and legally bind you. By staying in the Class, you released your right to sue Anthem for any and all known and unknown claims for relief, causes of action, suits, rights of action, or demands, at law or in equity, whether sounding in contract, tort, equity, or any violation of law or regulation, including, without limitation, claims for injunctive or other equitable relief, damages, debts, indemnity, contribution, or for costs, expenses and attorney’s fees, that were or could have been brought in the Lawsuits relating to the marketing and/or sale of ACA Health Plans, including issues relating to the accuracy of provider directories.

16. What happens if I do nothing at all?

Answer:

If you do nothing, you will get a settlement check (if you qualify for one) and benefit from Anthem’s agreement to undertake measures to improve: the size of the ACA-compliant plans’ provider network; member, provider, and broker understanding about ACA-compliant plans; and accuracy of provider lists. Going forward, Anthem will treat a provider as in-network for billing purposes if a provider is listed in- network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services. If you do nothing, you cannot sue, continue to sue, or be part of any other lawsuit against Anthem relating to the legal issues in the Lawsuits.  See Qs. 15 and 20.

17. Could I have objected to the settlement?

Answer:

Yes. If you did not opt-out of the settlement, you had the right to object to the proposed settlement if you did not think it was fair, reasonable, or adequate. You could have given reasons why you think the Court should not have approved it.

18. How could I have objected to the settlement?

Answer:

Your objection must have:

(a) Identified the coordinated case name and number (Anthem Blue Cross Affordable Care Act Cases, Judicial Council Proceeding No. 4805);
(b) Identified yourself as a Settlement Class Member;
(c) Attached copies of materials you will submit to the Court or present at the Fairness Hearing (if any);
(d) Been signed by you; and
(e) Clearly stated in detail: (1) the legal and factual ground(s) for the objection; (2) your name, address
and, if available, telephone number; and (3) if represented by counsel, such counsel’s name, address and telephone number.

To have your objection or comment considered by the Court, your written objection or comment must have been postmarked no later than July 5, 2016 and mailed to the following address:

Felser Settlement Administrator
P.O. Box 2508
Faribault, MN 55021-9508

19. Who resolves any disputes over the settlement?

Answer:

The Honorable Elihu M. Berle of the Los Angeles Superior Court, who is presiding over the Lawsuits, will consider your objections and decide disputes regarding any aspect of your participation in the settlement, including whether or not you are a Settlement Class Member. Do not call or write the Court directly about the Lawsuits.

20. What happens if I didn’t exclude myself (opt-out)?

Answer:

If you did not opt-out of the settlement, you may be entitled to a payment under the settlement.  However, you will not be able to sue Anthem on the legal issues in the Lawsuits, meaning you will release your right to sue Anthem for any and all known and unknown claims for relief, causes of action, suits, rights of action, or demands, at law or in equity, whether sounding in contract, tort, equity, or any violation of law or regulation, including, without limitation, claims for injunctive or other equitable relief, damages, debts, indemnity, contribution, or for costs, expenses and attorney’s fees, that were or could have been brought in the Lawsuits relating to the marketing and/or sale of ACA Health Plans, including issues relating to the accuracy of provider directories.

21. What happens if I excluded myself (opted-out)?

Answer:

If you opted-out of the settlement, you are not be entitled to a payment under the settlement and you cannot object to the settlement. However, you may be able to sue Anthem on the legal issues in the Lawsuits.

22. How could I exclude myself (opt-out)?

Answer:

In order to have excluded yourself, you must have sent a written request to the address listed below.  Your written opt- out request must have:

(a) Identified the coordinated case name and number (Anthem Blue Cross Affordable Care Act Cases, Judicial Council Proceeding No. 4805);
(b) Be signed by you;
(c) Clearly expressed your desire to be excluded (or to “opt-out”) from the Settlement Class; and
(d) Included your name, address and, if available, telephone number and, if represented by counsel, counsel’s name, address and telephone number.

If you asked to be excluded, you will not receive any settlement payment, and you cannot object to the settlement. However, you reserve your right to sue Anthem on the legal issues in the Lawsuits.

If you wished to opt-out from the Class, you must have sent an opt-out request by mail. The opt-out request must have been postmarked no later than July 5, 2016 and mailed to the following address:
 
Felser Settlement Administrator
P.O. Box 2508
Faribault, MN 55021-9508

23. If I excluded myself, can I get money from the settlement?

Answer:

No.  If you excluded yourself then you cannot receive a payment from the settlement.

24. What is the difference between objecting and excluding myself (opting-out)?

Answer:

Objecting is simply telling the Court what you do not like about the settlement. You can object only if you stay in the Class. If you exclude yourself, you have no basis to object because the case no longer affects you.

25. Who represents my interests in this settlement?

Answer:

The attorneys who represent the Class Representatives and Class Members include lawyers for Consumer Watchdog, Shernoff Bidart Echeverria Bentley LLP, The Arns Law Firm, Law Offices of Scott C. Glovsky APC, and Martinez Law Office, Inc. Together, the lawyers are called “Class Counsel.” You will not be charged for these lawyers. If you want to be represented by your own lawyer, you may hire one at your own expense.

If you wish to contact Class Counsel, please contact:

Michael J. Bidart
Travis M. Corby
SHERNOFF BIDART ECHEVERRIA BENTLEY LLP
600 South Indian Hill Boulevard
Claremont, CA  91711
Tel: (909) 621-4935
Fax: (909) 625-6915

http://www.shernoff.com/
 
Jerry Flanagan
Laura Antonini
CONSUMER WATCHDOG
2701 Ocean Park Blvd., Suite 112
Santa Monica, CA 90405
Tel: (310) 392-0522
Fax: (310) 392-8874
http://www.consumerwatchdog.org/
 
 
Robert S. Arns
Julie C. Erickson
Robert C. Foss
THE ARNS LAW FIRM
515 Folsom Street, Third Floor
San Francisco, CA 94105
Telephone: (415) 495-7800
Facsimile: (415) 495-7888
http://www.arnslaw.com
 
Scott C. Glovsky
Ari Dybnis
LAW OFFICES OF SCOTT C. GLOVSKY, APC
100 E. Corson Street, Suite 200
Pasadena, CA 91103
Telephone: (626) 243-5598
Facsimile: (866) 243-2243
http://www.scottglovsky.com/

26. Why are the lawyers representing the Class recommending settlement?

Answer:

The Class Representatives and Class Counsel are supporting this settlement because it provides substantial benefits to Class Members. Settlement avoids the time and uncertainty of litigation and provides Class Members immediate relief, rather than waiting for possible relief years from now.

All Class Members will have the opportunity to recover 100% of out-of-pocket expenses for medical services rendered by an out-of-network professional in 2014. For many affected Class Members, they will not need to do anything to get their check and no claims process is required.  All Anthem customers will benefit from Anthem’s agreement to treat any provider as in-network for billing purposes if that provider is listed as in-network on Anthem’s Provider Directory and a member relies on that network status when seeking medical services.

27. Do I have to pay any money to participate in this settlement?

Answer:

No.  You do not have to pay any money to participate in this settlement. You will not be required to pay any attorneys’ fees or costs if you remain in this lawsuit.

28. Who pays the lawyers?

Answer:

Anthem has agreed to pay Class Counsel fees and costs, which must be approved by the Court, in an amount not to exceed $3,950,000.00.  Class Counsel also requested an additional amount for each of the ten plaintiffs who acted as Class Representatives of $5,000 each, which is also subject to Court approval.  These amounts will not come out of the fund for payments to Class Members.

29. When and where will the Court decide whether to grant final approval of this settlement?

Answer:

A “Final Fairness Hearing” was held on August 12, 2016 at 9:00 a.m. before the Honorable Elihu M. Berle of the Los Angeles County Superior Court.  At this hearing the Court considered whether the settlement was fair, reasonable, and adequate and the settlement was approved.

30. Did I have to come to the hearing?

Answer:

No. If you did not opt-out of the Class, you may have, but did not need to, attend the Final Fairness Hearing at your own expense.  If you sent an objection, you did not have to come to Court to talk about it.  As long as you mailed your written objection or comment on time, the Court considered it.

31. May I speak at the hearing?

Answer:

If you are a Settlement Class Member and you did not opt-out, you could have spoken at the Final Fairness Hearing. The Final Fairness Hearing date has passed.

32. When will the settlement take effect?

Answer:

This settlement was approved by the court and the Settlement Effective Date is October 31, 2016.

33. Are there more details about the settlement?

Answer:

This notice summarizes the proposed settlement.  More details are in the Settlement Agreement.  If you would like to obtain a complete copy of the Settlement Agreement, the Lawsuits, and other documents in support of the settlement that have been filed with the Court, you may review and download them on the Anthem Blue Cross settlement website: www.FelserAnthemBlueCrossACASettlement.com. You can also call the following toll-free telephone number for information about this settlement: 1-866-384-9362.

Disclaimer

Please do not contact either Anthem Blue Cross or the Court with questions about this Settlement. Any and all callers will be directed to this website. If you have questions, please refer to the Commonly Asked Questions and the other information posted here or contact the Settlement Administrator by writing to: Felser Settlement Administrator, P.O. Box 2508, Faribault, MN 55021-9508.
 
This site is not operated by Anthem Blue Cross. This class action Settlement is supervised by the Court and is administered by an administration firm that handles all aspects of claims processing. Anthem Blue Cross is not authorized to respond to questions from members of the Settlement Class regarding the Settlement.

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