The mom of an Arizona man who died after being unable to seek out psychological well being therapy is suing his well being insurer, saying it broke the regulation by publishing false info that misled its clients.
Ravi Coutinho, a 36-year-old entrepreneur, purchased insurance coverage from Ambetter, the most well-liked plan on HealthCare.gov, as a result of it appeared to supply loads of psychological well being and dependancy therapy choices close to his dwelling in Phoenix. However after struggling for months in early 2023 to seek out in-network care coated by his plan, he wasn’t capable of finding a therapist. In Could 2023, after 21 calls with the insurer with out getting the therapy he sought, he was discovered lifeless in his condominium. His loss of life was dominated an accident, seemingly attributable to problems from extreme consuming.
Coutinho was the topic of a September 2024 investigation by ProPublica that confirmed how he was trapped in what’s generally often called a “ghost community.” Lots of the psychological well being suppliers that Ambetter listed as accepting its insurance coverage weren’t truly capable of see him. ProPublica’s investigation additionally revealed how customer support representatives and care managers repeatedly failed to attach Coutinho to the care he wanted after he and his mom requested for assist. The story was a part of a yearlong sequence, “America’s Psychological Barrier,” that investigated the methods insurers employed practices that interfered with their clients’ potential to entry psychological well being care.
The lawsuit, filed on Could 23 in Maricopa County by Coutinho’s mom, Barbara Webber, accused the insurer Centene, together with the subsidiary that oversaw her son’s plan, Well being Internet of Arizona, of publishing an “inaccurate and deceptive” supplier listing. The go well with additionally accused the businesses of breaking state and federal legal guidelines, together with ones that require directories to be saved correct.
The errors within the Ambetter listing gave Coutinho a misunderstanding concerning the sorts of psychological well being care that had been truly obtainable, the lawsuit mentioned. In keeping with the lawsuit, the failure to right these errors hid the truth that Centene corporations had supplied inadequate providers via the Ambetter plan.
The lawsuit attracts upon the findings of ProPublica’s investigation, summarizing Coutinho’s repeated makes an attempt to discover a therapist in Ambetter’s community and to get Centene representatives to attach him with a psychological well being supplier that he might truly see.
The lawsuit additionally describes how Arizona insurance coverage regulators had beforehand knowledgeable Well being Internet of Arizona that it had failed to take care of correct supplier directories. Well being Internet of Arizona promised to right the errors. Regulators didn’t positive the insurer and declined to reply ProPublica’s questions on whether or not the Centene subsidiary addressed their issues.
Centene and Well being Internet of Arizona didn’t reply to a number of requests for touch upon the lawsuit. ProPublica beforehand reached out to Centene and Well being Internet of Arizona greater than two dozen instances and despatched them each an in depth listing of questions. None of their media representatives responded.
One of many 25 largest corporations in America, Centene and its subsidiaries have been accused in previous lawsuits of purposefully misrepresenting the variety of in-network suppliers by publishing inaccurate directories. Centene legal professionals have beforehand denied such claims in two of the larger circumstances, in Illinois and California. Each circumstances are ongoing.
The highest commerce group for the trade, AHIP, has informed lawmakers that corporations contact in-network suppliers to make sure the listings are correct. AHIP additionally said that the businesses might right inaccuracies sooner if suppliers did a greater job updating their listings. Suppliers have informed ProPublica, nonetheless, that insurers don’t at all times take away their names from insurer lists after they formally request to depart their networks.
Mel C. Orchard III, a companion with The Spence Legislation Agency who’s representing Webber, informed ProPublica that he meant to deliver the case earlier than a jury to carry Centene accountable for negligence and shopper fraud. The lawsuit doesn’t state a specified quantity that Webber is searching for in damages.
“Ravi is an instance of the abject failure of the insurance coverage trade to do what it’s speculated to do — and that’s to insure us in instances once we want them probably the most,” Orchard informed ProPublica. “As an alternative they prey upon our vulnerabilities; that’s what occurred on this case.”
