Oscar Health Faces Class Action Over Illegal Breast Imaging Fees Charged to Insured Women
Class Action Lawsuit Against Oscar Health
In a significant legal development, two law firms, Jeeves Mandel Law Group, P.C. and Milberg Coleman Bryson Phillips Grossman PLLC, have initiated a class action lawsuit against Oscar Health Insurance in federal court. The lawsuit centers on allegations that the insurance provider has violated Texas state law by compelling female policyholders in Texas to pay deductibles and coinsurance for diagnostic breast imaging. This complaint raises critical questions about insurance compliance and the health of women affected by these policies.
Background of the Case
As of January 1, 2022, Texas law mandates that all medical insurers who issue non-ERISA medical policies in the state are required to cover the full costs of diagnostic breast imaging for their policyholders, eliminating any out-of-pocket expenses such as deductibles or co-pays. This legislation comes following a series of updates to insurance requirements aimed at ensuring women's health services are more accessible and affordable. However, the lawsuit claims that despite this law, Oscar Health has continued to charge its insured clients for part or even all costs associated with diagnostic breast imaging procedures.
The implications of these allegations are serious. As stated in the lawsuit, women, particularly those with health concerns or a history of breast cancer, may avoid necessary diagnostic imaging due to the financial burdens imposed by Oscar. This could, tragically, prevent early detection and timely treatment of potentially life-threatening conditions.
Legal Claims and Financial Stakes
The lawsuit is seeking over $5 million in damages, and potentially up to $30 million when factoring in statutory penalties, attorney fees, and other costs. The representative plaintiff, Lauren Moody, alongside other affected women argues that Oscar’s practices not only inflict economic harm but also pose significant health risks. Moody, who was subjected to these charges despite her doctor ordering crucial diagnostic imaging, expressed her frustration in the complaint, highlighting that her appeals were ignored, further compounding the core issues of trust and compliance in health insurance.
This recent lawsuit poses broader implications for how health insurance companies are monitored and held accountable under state and federal laws, particularly concerning women's health issues. The update to Texas law reflects a nationwide push to improve accessibility to healthcare services, particularly for women, and Oscar Health’s practices, as alleged, contradict these critical advancements.
Impacts on Women and Healthcare
Diagnostic breast imaging is vital for numerous women, especially those with dense breast tissue or previous cancer histories. The current lawsuit claims that Oscar Health has knowingly put profits over patient welfare, thereby risking the health of many who rely on this essential service.
Following the ACA's enactment, health insurance companies were required to cover specific preventive health services at no extra cost. However, Oscar is alleged to have not adhered to updates to Texas law that further expand these requirements. The claims indicate that the issue extends beyond Oscar Health, prompting conversations about the accountability of all insurance providers and how they treat policyholders.
Conclusion and Next Steps
With this lawsuit, the plaintiffs, led by Lauren Moody, seek not only compensation for overpaid medical expenses but also to enforce compliance with the Texas Insurance Code. As proceedings continue, it remains crucial for policyholders across Texas and beyond to stay informed about their rights and any potential changes affecting their health coverage.
This class action highlights a critical intersection of legal accountability and women's health, urging insurers to align their practices with both state and federal laws designed to protect policyholders. The legal teams emphasize that compliance is non-negotiable, advocating for transparency and integrity within health insurance systems. As this case unfolds, many will be watching to see its outcomes and potential ripple effects throughout the healthcare landscape.