1. Health Benefits- Anthem CalPERS PPO Litigation
John Jensen represents clients in health insurance benefit disputes.
Heinz et al v. Anthem CalPERS (BC664844, Los Angeles County Superior Court, Spring Street Courthouse.) is a proposed class action against Anthem Blue Cross and the California Public Employees Retirement System,and its Board of Administration (CalPERS) for Fraud, Misrepresentation, unfair business practices, and related claims regarding the promotional, sale, and reimbursement of out-of-network services in the PERS Care,PERS Choice, PERS Select (PERS Gold, PERS Platinum) PPO health insurance.
In the Heinz et al v. Anthem CalPERS matter, Plaintiffs allege Anthem-CalPERS made many misrepresentations of material facts, failures to disclose material facts and their documents patently misrepresent material terms of the PPO coverages including PERSCare, PERSChoice, PRESSelect, and other PPO coverages.
For Further Information about Litigation against Anthem CalPERS for misrepresentation, unfair business practice etc. regarding the promotion, sale, reimbursement, and related issues of the PPO health insurance click here.
Asserting that the reimbursement differed by a percentage of charge, higher co-payment, higher co-insurance, or higher percentage, was deceptive, unfair, misleading, and false, particularly as Anthem often reduced the “out-of-network” “Allowable Amount” base rates by more than the 20% to 30% difference in “percentage of charge,” co-insurance, or co-payment, in addition to reducing the reimbursement to 60% of the new reduced Allowable Amount base.
The representation of the “out-of-network” reimbursement as a “higher percentage of charge” et al was a material term as “out-of-network” claims were a significant advantage of PPO coverage. Anthem’s and CalPERS’ misrepresentations about the PPO’s benefits, advantages, and terms enticed individuals to buy, enroll, and re-enroll in PPO coverage, pay higher premiums, seek “out-of-network” services, and submit more “out-of-network” claims.
In other words, Anthem and CalPERS created a double, compounded reduction: Anthem and CalPERS (1) reduced the base Allowable Amount, and then (2) paid 60% of the newly reduced Allowable Amount base when it reimbursed out-of-network services.
CalPERS and Anthem’s misrepresentations and concealment made the PPO coverages and “out-of-network” benefits appear substantially more advantageous and more valuable than they were. The misrepresentation falsely inflated the coverage and value of the PPO, and caused subscribers to pay higher premiums and receive lesser coverage.
CalPERS is a fiduciary by law. Anthem is a fiduciary to enrollees by contract. Both have duties to disclose material facts to enrollees, including disclosing the reduced base rate for out-of-network services.
2.Litigation Pension Benefits- CalPERS CalSTRS CERL 1937 Act
Employee earn pension benefits as part of their overall compensation, financial security, and in retirement. California state employees , teachers, and local government employees have vested rights in their pension. However, sometimes the pension fund does not provide the correct benefits or miscalculates the benefits.
In select service retirement benefit cases, John Jensen represents employees and beneficiaries to achieve their proper pension due them.
We do not litigate disability determinations or disability benefits.
John Michael Jensen has litigated individual pension and beneficiary claims against the California Public Employees Retirement System (CalPERS), California Teachers Retirement System (CalSTRS), the Legislators Retirement System (LRS),the County Employees Retirement Law of 1937 (CERL) and others.