Centene sued for allegedly failing to provide adequate access to physicians: 5 things to know

An unidentified number of plaintiffs filed a lawsuit against Centene Corp. in federal court Thursday, claiming the health insurer failed to provide patients with adequate access to in-network physicians in approximately 15 states, The New York Times reports.

Here are five things to know about the lawsuit.

1. The lawsuit states Centene "misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers," making it difficult for members who purchased Centene policies to obtain access to providers at in-network rates.

2. The lawsuit also claims many physicians will not accept patients covered by Centene because of the insurer's refusal to pay legitimate claims, according to the report.

3. Steven Milman, DDS, founder of Round Rock (Texas) Periodontics and one of the plaintiffs in the lawsuit, told The New York Times he purchased an ACA plan from Centene last year. He said he chose Centene after learning its network included a large medical group in nearby Austin, Texas. However, Dr. Milman said shortly after signing with the insurer, he learned the medical group was no longer considered in-network. He called the physician's office assigned to him by Centene and learned it was an obstetrician and gynecologist office, which "[didn't] see men," according to the report.

4. A spokesperson for Centene told Becker's Hospital Review via email Thursday, "We learned of this lawsuit this morning. We have not been served with the lawsuit as of right now. However, we take these matters very seriously. We believe our networks are adequate. We work in partnership with our states to ensure our networks are adequate and our members have access to high quality healthcare."

5. The lawsuit comes nearly one month after Washington state regulators fined Centene up to $1.5 million for maintaining an insufficient network of physicians to treat patients who signed up for plans under the ACA, the report states. Regulators reportedly received 140-plus complaints from people who could not find in-network physicians or who received surprise bills following treatment.

To read The New York Times report, click here.

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast

Top 40 articles from the past 6 months