Blue Cross customer treatment examined, 27 years after last report released
Such reviews, conducted by states across the country, often look at how insurance companies advertise, enroll customers, pay medical claims and handle complaints. They're separate from rate reviews.
Without market conduct exams, it can be difficult to tell how the the insurer's 4.1 million members in
"It is one of those arcane things no one knows about, but it is super important," said
Rivals have faced scrutiny
Though the state hasn't publicly released a broad market conduct exam of
Since 1990,
The state also released a very narrow exam in 2011 of
"That's just way too long," said
"It would be surprising if there were not issues that have come up that didn't warrant there be some kind of a market conduct exam," said Jost, who is also a law professor at
Batkins also said he couldn't speculate as to why the
The department confirmed the exam this week only after being told about the Tribune's story, though it would not comment on ongoing exams in the fall when the Tribune first started asking questions.
She said the insurer has been in frequent contact with the department over the years.
Thousands in campaign gifts
In 2015 and 2016, the company made at least
"That's a serious presence and what you're doing with that money is basically you're building access, making friends, communicating," Redfield said.
Batkins, with the
Regardless of the reasons, a lack of oversight doesn't help consumers, Redfield said.
"It's not good regulation, and you're increasing the chances of bad things happening to consumers because you don't have effective oversight," Redfield said.
Tracking consumer complaints
Most consumers who feel frustration with a health insurer don't file a formal complaint -- but some do.
In
Exams performed on other
When issues are found, state regulators can work with insurers on formal agreements in which insurers to agree to fix the problems and sometimes pay a penalty. The fines have often been in the tens of thousands of dollars for insurers, though the state imposed a civil penalty of
But even
Still, it's a consequence, said
"The law requires you to treat consumers in a certain way," Birnbaum said. "If you fail to treat consumers in a certain way, if you violate the law, there's a penalty for that."
Some states levy penalties in the millions of dollars against insurers who do wrong by consumers.
Last fall,
That fine followed complaints from consumers that they couldn't get through to the insurer's customer service department, that they didn't get ID cards or proof of coverage, that they weren't properly billed for premiums and received incorrect policy cancellation notices, according to the settlement agreement.
Checks in other states
The
It's not uncommon for state reviews, across the country, to be somewhat spotty, experts say, though some acknowledge that 27 years is a long time to go without the results of an exam being released.
Some states perform reviews regularly while others only do them when they see a need, such as after a pattern of complaints, said
In
Market exams can also take a lot of work, man-hours and expertise. Examiners often visit an insurer's offices as part of an exam, going through documents.
"It's resource-intensive, and they don't always have enough resources, frankly," said
But a lack of resources, or at least a lack of funding, doesn't appear to be the reason behind the gap in exam reports on
"Insurance companies pay for market conduct exams, therefore state funding has no impact in this area," Batkins said in an email.
Experts, however, say other factors can also complicate states' oversight of insurers' market conduct.
Exams take years
Insurers can sometimes make it difficult for states to conduct the exams, Birnbaum said. Sometimes, years elapse between the beginning of an investigation and an actual settlement, he said.
"The market conduct examination has become such a formalized process that insurers have the ability to obstruct regulators every step of the way," Birnbaum said.
Different political administrations might also have differing ideas about how to handle exams.
In
The department has had 17 directors or acting directors since 1990, the last time results of a comprehensive market conduct exam on
A spokeswoman for Gov.
Some are trying to improve regulation of health insurers' market conduct across the country, in hopes of making it easier for states to regulate insurers' behavior.
Starting in fall 2018, most states will start requiring health insurers to submit market conduct data to them each year, through an effort organized and facilitated by the
But for now, market conduct exams remain a key way for the state to hold insurers accountable for following certain laws.
Batkins said the
"Three decades is a really long time and the idea that there might not be any problems whatsoever seems very unlikely," said Imholz with
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