Sacramento, California – After finding that Anthem Blue Cross frequently failed to handle member complaints correctly over the course of many years, California officials have fined the company $15 million. The Department of Managed Health Care said the problems were both widespread and long-lasting.
State authorities said that punishment comes after years of work to fix how Anthem Blue Cross handles complaints and appeals from its members. The company will have to engage with an independent auditor for up to four years as part of the most recent proceedings. The auditor will look at how the plan handles complaints and tell the department directly if the changes are effective.
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The agency says that Anthem Blue Cross has consistently failed to appropriately identify concerns, respond in a timely manner, or even resolve issues at all. Regulators stated these problems had been going on for more than 15 years, even despite many fines and written warnings.
California law protects consumers by giving them the right to file complaints and appeals. Health plans must tell their members about their rights, react to complaints within a certain amount of time, and let members know how to ask for an Independent Medical Review if their care is rejected, delayed, or modified. State officials noted that problems with this system can keep patients from getting the care they need.
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The department’s most recent audit revealed that Anthem Blue Cross’s complaint handling was not up to par in several ways. Investigators found that the plan typically didn’t treat oral concerns as formal grievances and didn’t always fix problems once they were found. In over half of the cases we looked at, complaints weren’t correctly categorized, and in many others, the necessary follow-up activities weren’t taken.
The $15 million fine is only the latest in a long line of fines against the insurance company. The government has fined Anthem Blue Cross millions of dollars in the past few years for late or missing grievance notices, delays that compromised cancer treatment, and recurrent infractions related to handling complaints.
Anthem Blue Cross must show that it is making steady progress while being watched by an outside party, according to the latest enforcement order. Regulators said the plan’s purpose is to protect the rights of its members and make sure it follows all state laws.
The Department of Managed Health Care informs members to make a complaint with their plan if they have concerns with their health coverage, such as being denied, having to wait, or having other issues. If the problem isn’t fixed or is urgent, members can call the department’s Help Center for help.