Blue Cross ACA Fiasco Still Under Review, North Carolina Says
Aug. 22--The N.C. Department of Insurance broke its silence Monday on its long-running investigation of Blue Cross and Blue Shield, saying the health insurer disputes the agency's findings of wrongdoing and the matter will require further examination.
The insurance department launched an investigation of Blue Cross, the state's largest health insurer, in February as thousands of Blue Cross customers were complaining that they were double-billed, dropped from coverage or assigned to health plans they had not selected. The investigation is confidential under North Carolina law, and the details of the insurance department's findings have not been made public.
When discussing the investigation earlier this year, Insurance Commissioner Wayne Goodwin said he expected his agency would fine Blue Cross in the millions of dollars.
The insurance department submitted its initial findings to Blue Cross on May 31, and the insurer challenged the agency's determinations. Since then, Goodwin has declined to provide status updates. State law allows an insurer and state investigators to exchange information and hold internal agency hearings if there's a dispute over the agency's findings.
"The North Carolina Department of Insurance determined further examination of Blue Cross Blue Shield is necessary," the agency said in a statement. "The initial examination report was delivered to BCBS on May 31, 2016. Interactions with Blue Cross Blue Shield have been ongoing but disagreements on the findings persist."
As of July, the insurance department has received 3,343 complaints about Blue Cross, including 290 from medical providers who said they hadn't been paid by the insurance company. Blue Cross's operational problems were not fully resolved in July; that month the insurance department received 121 complaints, including 18 from medical providers.
Blue Cross's enrollment problems surfaced in January, at the beginning of the new coverage year for the Affordable Care Act and other individual policies that customers buy directly from the insurance company. Blue Cross blamed malfunctioning software for the disruptions, which left thousands of customers stranded without coverage, prompting the Department of Insurance to intervene for customers in dire medical situations.
Doctors and other medical providers have also filed complaints, some saying they had not been reimbursed by Blue Cross for several months.
At least two Blue Cross executives resigned over the fiasco, including Alan Hughes, the company's former chief operating officer who was in charge of technology implementation.
John Murawski: 919-829-8932, @johnmurawski
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