One Medical Group Patients Not Told that Annual Membership Fees Are Optional, Class Action Alleges [DISMISSED]

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A proposed class action alleges One Medical Group, Inc. has falsely represented that payment of its annual membership fee is mandatory in order for a patient to receive medical services at one of its more than 60 offices.

The 38-page lawsuit alleges that although One Medical “members” pay anywhere from $149 to $199 per year in fees, the defendant has failed to disclose that neither membership nor payment of the annual fee is required to make an appointment at a One Medical office or receive medical services from one of the company’s providers.

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Per the case, it is a “well-kept secret” that One Medical’s annual fee is optional and only provides access to the company’s mobile app and online appointment booking and messaging services. What consumers are not told by One Medical is that those with health insurance are entitled to receive covered medical services at no additional cost aside from their co-pay and deductible, the suit alleges.

Thus, the company’s representation that its annual fees are mandatory in order to book an appointment and receive covered medical services is “fundamentally deceptive” and allows One Medical to collect fees it otherwise would not be paid, the lawsuit claims. According to the complaint, One Medical knows that it is prohibited from charging extra-contractual fees for covered services, but consumers do not, and the company, the suit alleges, “capitalizes on this informational disadvantage” by charging unnecessary fees.

Per the lawsuit, One Medical provides primary care services through a network of providers at its more than 60 offices nationwide. The lawsuit says that those services are covered as in-network visits under many large insurance plans, including Aetna; Anthem Blue Cross, Blue Shield; Chinese Community Health Plan; Cigna; Health Net; and United Health Care. According to the suit, One Medical’s contracts with these insurers prohibit “pay-to-play” fees such as the company’s annual membership fees, and such fees are also barred under the Affordable Care Act.

Nevertheless, most consumers are unaware that they are entitled to receive medical services covered by their insurance plan at no additional cost aside from their co-pay and deductible, the case says.

In fact, the suit says that One Medical fails to disclose to patients at any point during the enrollment process that its membership fee is optional for individuals with insurance for which the company is an in-network provider, and that the fee only covers the use of One Medical’s mobile application and website portal, which allow patients to request prescription refills online, book appointments and communicate with clinicians. Per the case, One Medical patients would not choose to pay the company’s annual membership fee for services already covered under their insurance if they knew it was optional. Nevertheless, there is “no practical way” for consumers to opt out of the fees and still obtain medical services through the company, according to the complaint.

The lawsuit claims that at least one health insurance company has warned the defendant “about the impropriety of its conduct.” Indeed, CareFirst BlueCross BlueShield allegedly sent a letter to policyholders in March 2017, stating that One Medical’s annual membership fee was optional under the insurer’s agreement with the company.

The suit alleges the only purpose of One Medical’s “sustained, deliberate deception” regarding its annual membership fee is to “maximize revenue.”

The lawsuit, which was initially filed in Miami-Dade County Circuit Court on February 4 before being removed to Florida’s Southern District Court on March 18, looks to represent anyone in the U.S. who paid One Medical’s annual membership fee during the applicable statute of limitations period through the date a class is certified.

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