Anthem Blue Cross Blue Shield was fined $5 million Tuesday for numerous violations of state law, the largest in state history. Georgia Insurance and Safety Fire Commissioner John F. King said his office investigated 78,000 violations from 2015.
“This examination uncovered a number of serious issues, including improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories, and significant delays in loading provider contracts,” King said Tuesday.
“For example, a doctor who signs a contract will be part of the network, but it took between six seven up to nine months for the doctor to actually become part of the network, which continues the treatment to the consumers,” King said as he described the nature of the complaints. “They were being basically charged out of network rates and not responding to charges. And the last one is when we had inquiries into Anthem Blue Cross, they were not responding. So those are the three major buckets of violations that we found.”
To avoid additional penalties, Blue Cross Blue Shield must develop a new process for handling regulatory provider complaints, pay claims within the timeframes established under state law, and load provider contracts in a timely manner.
“After numerous complaints made to our office regarding the operations of Blue Cross Blue Shield from individuals, physicians, hospitals, and others from around the state, I instructed my staff to conduct an extensive examination into the carrier’s practices,” King said.
King said his job is to be the consumer advocate for the state of Georgia.
“I represent consumers across our state, King explained. “The message is, don’t be doing this or else we’re going to hold you accountable. We routinely look at all insurance companies, but what drives our investigations especially that conduct market conduct exam is a very thorough and very focused investigation driven by complaints that were filed against these companies to our agency.”
King said the agency does not have current or ongoing investigations to this extent. However, he said his team regularly looks at all insurance companies to make sure that their behavior is consistent with the law.