It’s something that many people face with their health insurance — determining whether or not their doctor is in-network.
That issue and others have led Georgia’s Insurance Commissioner’s Office to impose its biggest fine ever against an insurer. The state fined Anthem Blue Cross Blue Shield $5 million.
Part of the issue? Patients were told their doctors were in-network, when they actually weren’t.
Georgia Insurance Commissioner John King says his office has received about 78,000 complaints about Anthem Blue Cross Blue Shield over a period of about five years.
“We determined that Anthem Blue Cross Blue Shield was engaging in a pattern by pattern behavior that was in violation of the Georgia state rules and laws,” King told the I-TEAM.
Those violations include:
- Inaccurate provider directories
- Failure to reply to consumer complaints in a timely manner
- Improper claims settlement practices
King said one of the biggest issues is Anthem Blue Cross Blue Shield would provide inaccurate information about what doctors and hospitals were in-network.
“You want to continue in a relationship with your doctor. And then all of a sudden, you find that your doctor is out of network, which drives the cost for the care that you have received,” King said.
Laura Colbert, the executive director of the consumer health advocate group Georgians for a Healthy Future, says that’s an issue with other insurance companies, too.
“Finding out your provider is out of network, when your insurance company shows that they’re in-network, is a pretty regular occurrence,” Colbert said.
The insurance commissioner’s office says a lot of the issues with Anthem Blue Cross Blue Shield stemmed from issues with a provider database that the company launched 2015, and after that, complaints jumped.
But King says he’s confident the company will correct the issue.
A consent order signed by the Georgia commissioner of insurance and the president of Anthem Blue Cross Blue Shield Georgia shows they’ve agreed to a $5 million fine and a corrective action plan for the insurance company.
A spokesperson for Anthem says they have replaced the database system that caused issues with a new platform to improve accuracy and transparency, saying: “We are dedicated to those we serve and partner with, and we believe the recent enhancements we have made will create an improved overall care provider experience.”
The Georgia insurance commissioner’s office says to avoid additional penalties, Anthem Blue Cross Blue Shield must develop a new process for handing complaints, pay claims within the timeframes established by state law, and load provider contracts to go in-network in a timely manner.