Centene hit with federal lawsuit claiming inadequate provider access
Lawsuit said beneficiaries have trouble finding, and sometimes cannot find, medical providers who'll accept the coverage.
Centene has been hit with a federal lawsuit for alleged failure to have an adequate number of providers in its 15-state network.
The lawsuit was filed Thursday, Jan. 11, in federal court in Washington State, according to The New York Times.
The lawsuit said beneficiaries have trouble finding, and sometimes cannot find, medical providers who will accept Centene coverage.
[Also: Centene subsidiary in Washington State fined $1.5 million over provider deficiencies]
It also claims the insurer misrepresented the number of physicians in its network, as some providers have asked to be removed due to the insurer's refusal to pay claims, the report said.
"We work diligently to build networks that meet regulatory standards and include a wide array of quality providers," Centene said by statement. "We take these matters very seriously. We work in partnership with our states to ensure our members have access to high quality healthcare and our networks meet or exceed adequacy requirements."
The lawsuit follows a Dec. 15 order by the insurance commissioner in Washington State for Centene subsidiary Coordinated Care Corporation to pay a $1.5 million fine and to fix deficiencies in its provider network. All but $1 million of the fine was suspended if there were no further violations over the next two years.
Coordinated Care had until today to pay the $500,000 fine.
Washington Insurance Commissioner Mike Kreidler said his office had received over 100 complaints about Coordinated Care's inadequate network and surprise bills from out-of-network charges.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
