Blue Cross of California d/b/a Anthem Blue Cross is a California Stock Corporation with its principal place of business in Woodland Hills, California. Anthem sells health insurance and related administrative services to California employers, individuals, and families.
AA Insurance Advocacy, Inc. is a California-based company that was incorporated on May 21, 20212. The company is registered as a California Stock Corporation and is currently active. The principal address for the company is 1421 Ambassador Street, Unit #212, Los Angeles, CA 900352. Alanna Apfel is listed as the Chief Executive Officer, Chief Financial Officer, Director, and Secretary of the company. She is an insurance patient advocate who helps patients with employer-sponsored PPO insurance negotiate with insurance companies to cover their out-of-pocket mental health therapy costs or services provided by out-of-network therapists.
According to a Civil Complaint filed on February 3, 2025 in the Los Angeles County Superior Court, Anthem alleges that Apfel and her Corporation submitted “fraudulent claims for out-of-network healthcare services that were misrepresented, inflated, or never provided at all.” Anthem further alleges that “This scheme was carried out by Alanna Apfel, on her own behalf and through AA Insurance Advocacy, Inc., an entity through which she presents herself to Anthem members and the public as an “insurance advocate” that will negotiate with Anthem (and other insurers) to maximize reimbursement for certain out-of-network medical expenses.”
To date, Anthem alleges it “has already identified more than $7.6 million dollars in payments that were directly caused by Ms. Apfel’s fraudulent requests for out-of-network authorizations and/or submission of claims on behalf of more than 480 Anthem members.” And it further alleges that this “figure is highly conservative, with the true amount of loss expected to grow dramatically as Anthem continues its investigation.” Anthem provided details in the allegations of its lawsuit.
“In reality, Ms. Apfel generates additional reimbursement not through advocacy, but rather by falsely seeking out-of-network authorizations and creating sham out-of-network medical claims for healthcare services. She then submits those claims to Anthem to obtain reimbursement payments to her member-clients for services never rendered or which are far in excess of what the healthcare providers actually charged and the members actually paid for.” Anthem further alleges that “Ms. Apfel then charges Anthem members a fee for her “services,” typically based on a percentage of these inflated reimbursements as a kickback for submitting the falsified claims on the members’ behalf.”
“Ms. Apfel typically starts with a request for a “network exception” for the member: a way for the member to see an out-of-network provider so that, in theory, the member can receive reimbursement from Anthem for the full out-of-pocket costs supposedly paid to the provider by the member for that authorized, out-of-network care.” Anthem then claims that when “Anthem, predictably, is unable to identify an appropriate in-network provider satisfying Ms. Apfel’s numerous requirements, it will authorize the out-of-network referral and provide the member with a network exception which requires Anthem to reimburse the member for the actual out-of-pocket costs paid to that out-of-network provider.”
“Ms. Apfel’s and Defendants’ “advocacy” was designed to fraudulently intervene and capitalize on this out-of-network reimbursement process by, depending on the case, grossly inflating or completely fabricating services supposedly rendered by the out-of-network provider and paid for by the member. This caused, and continues to cause, Anthem to pay out millions of dollars to reimburse members for costs they never actually incurred.”
Anthem provided several examples of the alleged fraudulent scheme, all involving inflated schemes for psychotherapy with various mental health practitioners. In one example, “Anthem member K.S. retained Ms. Apfel to obtain reimbursement for treatment from out-of-network provider Dr. Joseph Whitcomb, PsyD, LMFT, a provider who had previously treated K.S.”
“Based on Ms. Apfel’s representations, Anthem authorized an out-of-network referral/network exception for K.S., in good faith, to treat with Dr. Whitcomb for in-office treatment from May 1, 2023 through April 29, 2024. On or about January 9, 2024, Anthem renewed the authorization for in-office treatment from Dr. Whitcomb from January 1, 2024 through December 31, 2024.”
“Dr. Whitcomb, however, could not have treated K.S. during this timeframe because he had moved to Europe years earlier in 2021, shortly after K.S. had originally stopped treating with him.” Anthem alleges that “Apfel submitted a claim for reimbursement on behalf of K.S. which included a fraudulent bill Ms. Apfel had created purporting to show that, in March 2024, K.S. had received 17 sessions of psychotherapy from Dr. Whitcomb at a cost of $675 per session, and that K.S. had paid Dr. Whitcomb $11,475 for this period.”
Further, Anthem alleges “Dr. Whitcomb died suddenly on May 18, 2024 while in Europe. Roughly one month after his death, on June 16, 2024, Ms. Apfel submitted a claim for reimbursement on behalf of K.S. which included a fraudulent bill Ms. Apfel had created showing that, in May 2024, K.S. supposedly had received 23 sessions of psychotherapy from Dr. Whitcomb at a cost of $995 per session, including 10 sessions that purportedly occurred after Dr. Whitcomb’s May 18, 2024 death, and that K.S. had paid Dr. Whitcomb $22,885 for this period.”
No answer or other responsive document has been filed in the Superior Court by any defendants as of the date of this report.