The mom of an Arizona man who died after being unable to search out psychological well being therapy is suing his health insurer, saying it broke the regulation by publishing false data that misled its prospects.
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 search out in-network care lined by his plan, he wasn’t capable of finding a therapist. In Might 2023, after 21 calls with the insurer with out getting the therapy he sought, he was discovered lifeless in his condo. His dying was dominated an accident, possible on account of issues from extreme consuming.
Coutinho was the topic of a September 2024 investigation by ProPublica that confirmed how he was trapped in what’s generally referred to as a “ghost community.” Most of the psychological well being suppliers that Ambetter listed as accepting its insurance coverage weren’t really in a position to 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 Mental Barrier,” that investigated the methods insurers employed practices that interfered with their prospects’ capacity to entry psychological well being care.
The lawsuit, filed on Might 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 Web of Arizona, of publishing an “inaccurate and deceptive” supplier listing. The swimsuit 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 really out there, the lawsuit stated. In keeping with the lawsuit, the failure to right these errors hid the truth that Centene corporations had offered inadequate companies by way of 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 really see.
The lawsuit additionally describes how Arizona insurance coverage regulators had beforehand knowledgeable Well being Web of Arizona that it had failed to keep up correct supplier directories. Well being Web of Arizona promised to right the errors. Regulators didn’t fantastic the insurer and declined to reply ProPublica’s questions on whether or not the Centene subsidiary addressed their considerations.
Centene and Well being Web of Arizona didn’t reply to a number of requests for touch upon the lawsuit. ProPublica beforehand reached out to Centene and Well being Web of Arizona greater than two dozen occasions and despatched them each an in depth record 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 business, AHIP, has instructed lawmakers that corporations contact in-network suppliers to make sure the listings are correct. AHIP additionally acknowledged that the businesses might right inaccuracies sooner if suppliers did a greater job updating their listings. Suppliers have instructed ProPublica, nonetheless, that insurers don’t all the time take away their names from insurer lists after they formally request to depart their networks.
Mel C. Orchard III, a accomplice with The Spence Legislation Agency who’s representing Webber, instructed ProPublica that he supposed to carry 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 business to do what it’s presupposed to do — and that’s to insure us in occasions once we want them essentially the most,” Orchard instructed ProPublica. “As a substitute they prey upon our vulnerabilities; that’s what occurred on this case.”
