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Case Review Nurses Sue Insurer Over Overtime Demands

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What You Need to Know

  • The suit was filed in Atlanta.
  • Deon Baker is seeking to represent a class of utilization review nurses.
  • Baker had to work as many as 60 hours per week without receiving overtime pay, according to the complaint.

A proposed class action filed earlier this week in federal court in Atlanta accuses the Anthem — the parent of Blue Cross Blue Shield health care plans in Georgia — of violating the Fair Labor Standards Act by requiring Georgia nurses to work more than 40 hours a week with no paid overtime.

The nurses were responsible for reviewing health insurance claims to see whether the care provided was medically necessary.

According to the complaint, the proposed class includes anyone who has worked for Anthem in Georgia as a medical or utilization management nurse, utilization review nurse, nurse reviewer or associate, or in “other similar positions who were paid a salary and treated as exempt from overtime laws and whose primary job was to perform medical necessity reviews” during the past three years.

The complaint was filed on behalf of Deon Baker, who worked as a medical management nurse from December 2015 to July 2020.

Baker “and the other similarly situated individuals’ primary job duty is non-exempt work consisting of reviewing medical authorization requests submitted by healthcare providers against pre-determined guidelines and criteria for insurance coverage and payment purposes,” the nurses said in the complaint.

Banker and other members of the proposed class were paid a salary with no overtime pay, despite working as many as 60 hours a week at times, according to the complaint.

Anthem knew about the unpaid overtime “because Plaintiff and others complained about their long hours and the workload,” the nurses said. ”Specifically, when Plaintiff told her supervisor that she was working long hours, including working nights and weekends, her supervisor responded that she could not change the workload because the company would not be hiring additional workers.”

Despite being legally required to do so, Anthem “did not make, keep or preserve adequate or accurate records of the hours worked by Plaintiff and the other similarly situated individuals,” the nurses said.

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Attached to the complaint are consent forms from 13 more similarly employed nurses who have worked for Anthem in the last three years and agreed to join the action.

“As this case proceeds, it is likely that other individuals will file consent forms and join as ‘opt-in’ plaintiffs,” the nurses said.

Anthem provides or administers health coverage for about 74 million people in the United States.

The complaint was filed in the U.S. District Court for the Northern District of Georgia by John Sparks Sr. of Austin & Sparks in Atlanta, who referred questions to his co-counsel Caroline Bressman and Rachhana Srey of Nichols Kaster in Minneapolis.

Those lawyers did not immediately provide a comment.

An Anthem spokesperson to whom a copy of the complaint was forwarded said the company had not been served with it yet and would have no comment.

Pictured: Anthem’s world headquarters in Indianapolis. (Photo: Jonathan Weiss/Shutterstock)