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Health

City Attorney Sues Three Health Insurers Over Alleged Misleading Directories

The San Diego Superior Court is shown in this undated photo.
Milan Kovacevic
The San Diego Superior Court is shown in this undated photo.

The San Diego City Attorney's Office filed lawsuits Friday against a trio of health insurers for allegedly misleading consumers regarding the scope of coverage and services within their networks.

Kaiser, Molina Healthcare and HealthNet are accused of falsely representing what services are available through their plans by inaccurately listing which doctors are within their networks, according to the lawsuits filed in San Diego Superior Court.

The City Attorney's Office alleges that by publishing inaccurate provider directories, which many consumers use to gauge which insurance plans to purchase, health insurance companies benefit by making their coverage appear more comprehensive than it actually is and therefore more inviting for potential enrollees.

These "ghost networks" also help insurers weed out patients who require specialized and often expensive care, as they may become frustrated with repeated, failed attempts to obtain coverage through the inaccurate directories, the lawsuits allege.

A Kaiser spokeswoman said the company had not yet seen the complaint and could not comment. Molina Healthcare and HealthNet did not immediately respond to requests for comment.

According to the City Attorney's Office, Molina's directories have an error rate of as high as 80%, while Kaiser and HealthNet have inaccuracy rates of at least 35%.

"Consumers should be able to trust their health insurers when seeking medical attention," San Diego City Attorney Mara Elliott said. "Error- filled directories create dangerous barriers to health care services, with patients struggling to find a directory-listed doctor who will accept their insurance. These misleading ghost networks not only violate state law but undermine the health of San Diegans and Californians."

The suits allege false advertising and unlawful business practices under both state and federal law.

More than 1 million people statewide are enrolled in the three companies' health plans, according to the City Attorney's Office.