New ObamaCare Suits Making Insurers Queasy

In response to the Affordable Care Act, insurance companies have lowered the cost of health coverage by limiting the number of doctors in their payment networks. This “narrow network” strategy has sparked a number of class-action and group lawsuits, and now Health Net Inc. faces one involving a single policyholder. The suit, filed by downtown firm Gianelli & Morris, claims the Woodland Hills insurer failed to establish an adequate network to deliver the care promised in a plan sold under the health reform law. As a result, the firm’s client sustained a permanent disabling injury to his hand. Most narrow network suits are class action plays that allege policyholders were denied care required by law or were improperly charged for seeing out-of-network doctors. Anthem Blue Cross in Thousand Oaks, a unit of Indianapolis-based Anthem Inc., was hit by several such suits over the summer. One filed by Santa Monica-based Consumer Watchdog alleged the company misled millions of policyholders. But Robert Gianelli, lead attorney in the Health Net case, sees more individual narrow network suits as a result of ObamaCare. “This is the natural consequence of not having adequate networks,” he said. “If these plans ultimately develop adequate networks, it will diminish, but for the last year they haven’t.” A study last year by consulting firm McKinsey & Co. found narrow networks offered consumers premiums that were 13 to 17 percent lower than broad networks, depending on the type of plan. Nationally, nearly 70 percent of the lowest-priced plans on the market have narrow networks, according to McKinsey. Gianelli said that networks narrow when insurers lower their reimbursements to the point that some doctors just won’t participate. “How much these company are making is another story,” he said. The Health Net suit concerns Terry LaRue, who became covered under a Health Net IFP CommunityCare HMO plan in May. A few days later, while working as a freelance videographer, he injured his hand. He went to an emergency room in Denver where he was diagnosed with a fracture and referred to an orthopedic surgeon. But the surgeon wouldn’t accept LaRue’s Health Net coverage. After seeing a series of doctors, LaRue finally received the surgery seven weeks after first contacting Health Net. The suit alleges that because of the delay, LaRue suffered a permanent impairment of his hand and can no longer work, resulting in financial losses. It alleges breach of contract and fraud, and seeks unspecified compensatory and punitive damages. A Health Net spokesman provided a statement that the company “strives to provide members with access to quality care and help them navigate the health care system.” Previously, the company has stated that enrollment materials and its explanation of benefits clearly outline provider networks and benefits. Advocacy for Advocates Jill Friedman, a litigator at Myers Widders Gibson Jones & Feingold LLP, has joined the executive board for the California Coast Chapter of the American Board of Trial Advocates. The firm, based in Ventura, also has six other offices, including ones in Thousand Oaks and Valencia. It specializes in business law, including insurance, intellectual property and real estate. Friedman handles insurance and medical malpractice defense litigation. The American Board of Trial Advocates is an invitation-only organization. Nationally, women comprise less than 3 percent of the group’s membership, but Friedman is the third woman to be in leadership in the local chapter, which spans Ventura, Santa Barbara and San Luis Obispo counties. She will serve as membership chair in 2015 and is in line to be president in 2018. “It is a great honor to join the leadership of such a prestigious organization,” she said in a statement. She also serves on the Ventura County Bar Association board of directors and is a past president of Women Lawyers of Ventura County and Ventura County Barristers. Name Change Doron Tisser and Brian Standing have changed the name of their Woodland Hills firm to Tisser & Standing LLP. The pair have been working together for seven years in estate law, but earlier this year Standing received certification as an estate planning specialist, prompting the change to make him a name partner. “It’s part of getting my name out there and just letting people know it’s not just Doron anymore,” he said. The firm, formerly called Tisser Law Group, handles wills, probate, trust administration, tax planning, special needs trusts, charitable giving planning and the establishment of business entities such as LLCs and partnerships in connection with estate planning. “It’s a big umbrella but very specialized,” Standing explained. The firm has 12 employees but only two attorneys with plans to add a third this year. Staff Writer Joel Russell can be reached at (818) 316-3124 or [email protected].