LOS ANGELES, May 13, 2016 /PRNewswire/ -- A lawsuit filed by Theresa Barta on behalf of her clients LA Laser Center and Dr. Daniel Taheri, a skin cancer surgeon, against Anthem Blue Cross is asking the court to stop Blue Cross from limiting the size of its Covered California provider network, because it restricts patients' access to health care.
As explained in the lawsuit, an insurer's provider network (i.e., its network of contracted physicians), as well as the type and location of physicians in the network, greatly influences patients' access to health care and the quality of care they receive. The size of an insurer's provider network also affects an insurer's profits. The smaller the provider network (e.g., a "narrow" network), the less access patients have to physicians, and the more money the insurer retains as profits.
LA Laser Center and Dr. Daniel Taheri filed the lawsuit after Blue Cross denied their application to become participating providers in Blue Cross' Covered California network. Even though LA Laser and Dr. Taheri meet Blue Cross' eligibility criteria and are currently Participating Providers in Blue Cross Prudent Buyer (PPO) Network, Blue Cross denied their application stating that the Blue Cross Covered California network is "a narrow network and not all Prudent Buyer physicians are included."
As set forth in the lawsuit, Dr. Taheri wrote to Blue Cross stating:
"We regularly turn over dozens and dozens [of patients] on a weekly basis for skin cancers and melanomas who are under the umbrella of Blue Cross California Care. There are NO OTHER DERMATOLOGISTS on panel within hundreds of miles in many of the communities that we practice. These patients have zero access to dermatologic care. They have complained to Blue Cross and were told to ask the provider [me] to apply."
The lawsuit alleges that Blue Cross unlawfully and unfairly excludes qualified physicians from its Covered California network solely for financial gain and profit. The lawsuit also explains that Blue Cross' conduct results in patients having to delay, or forego, medical care and treatment, because there are too many patients and too few physicians.
The complaint was filed in Los Angeles Superior Court. LA Laser and Dr. Taheri are represented by Theresa J. Barta of Barta Law in Newport Beach, California.
SOURCE Barta Law