Colorado Regulators Fine Bright Health $1M For ‘Operational Problems’

The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has announced that as a result of an investigation of Bright Health, it is fining the company $1 million and is entering into a formal agreement with the company to address its issues with both consumers and health care providers.

Since 2021, the DOI has received over 100 consumer and health care provider complaints about Bright that indicated systemic operational problems. These complaints were focused around four areas - 1) failure to pay provider claims according to Colorado law; 2) failure to communicate with their members; 3) inability to accurately process consumer payments and accounts; 4) untimely processing of claims for physical and behavioral health coverage.

While Bright made some improvements as a response to the DOI’s initial inquiries into the complaints, the DOI believed that further action was warranted. Due to these violations, the Division has imposed a fine on Bright Health of $1 million ($750,000 for violations in 2021, and $250,000 for violations in 2022).

“With the number and variety of complaints the Division received, our investigation had to dig deep into many facets of their business. With this fine and the formal agreement outlining how Bright is going to fix their problems, they should not only be able to clear their backlog of complaints and payment issues, but be in a better position to serve Colorado consumers going forward,” said Colorado Insurance Commissioner Michael Conway.

Of the $1 million penalty, $500,000 must be paid now. Payment of the rest of the penalty is stayed upon Bright’s improvement and compliance with various steps and metrics such as: accurately paying past claims, providing reasonable resolution times for complaints (both complaints that are made to Bright directly, as well as those made to the Division), resolving claims disputes from health care providers, and a significant reduction in complaints about Bright to the Division.

Should Bright meet these requirements within the next 12 months, the remaining $500,000 penalty will be waived. If Bright fails to meet these requirements, the remaining $500,000 penalty will become due.

Bright Health has acknowledged these violations and agrees to the requirements being issued by the DOI. The company has fully cooperated with the Division on this matter.

“We appreciate Bright’s willingness to work with the Division to resolve these matters, not only for the company, but for its stakeholders - its members and health care providers,” added Commissioner Conway. “Bright has emphasized to us that the company takes its obligations to members and providers seriously and will work to make sure it is living up to its obligations. Over the coming year, the Division will monitor the company closely to ensure that it is righting the ship and moving towards better business practices.”

This report compiled by InsuranceNewsNet staff.