Anthem fined $5 million over consumer violations

Fine is the largest insurance commissioner has ever levied on an organization

Anthem fined $5 million over consumer violations

Insurance News

By Lyle Adriano

Georgia’s state insurance regulator has fined Anthem Blue Cross Blue Shield a hefty $5 million after an official investigation found that the insurer violated multiple consumer laws.

The $5 million fine is the largest Georgia’s Office of Commissioner of Insurance and Safety Fire has ever levied on an organization.

“As Georgia’s Insurance Commissioner, my number one priority is protecting Georgia consumers,” said Insurance and Safety Fire Commissioner John F. King in a statement. “To that end, after numerous complaints made to our office regarding the operations of Blue Cross Blue Shield from individuals, physicians, hospitals, and others from around the state, I instructed my staff to conduct an extensive examination into the carrier’s practices.”

At a recent press conference, King said that ever since he took his first day in office as commissioner, his agency has been “inundated” with complaints about Anthem from individuals, doctors, and even hospitals. To address the issues raised by the complaints, the commissioner launched a months-long Market Conduction Examination into Anthem.

“This examination uncovered a number of serious issues, including improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories, and significant delays in loading provider contracts,” said King. “As a result, our office has issued the largest fine in Agency history, with potential additional penalties if certain benchmarks are not reached.”

King also explained during the press conference this week that the “inaccurate provider directories” was the biggest problem with Anthem. Consumers usually pick their health insurer based on whether their doctor and/or hospital is within the company’s provider network. But it was found that in many cases, while patients saw their doctor/hospital listed on Anthem’s network, they later found out that they were not – this either led to patients paying full price for medical services, or care providers going unpaid.

The Atlanta Journal-Constitution reported that the fine against Anthem addresses the insurer’s mistakes with its provider database, but it does not address incidents where the insurer informed policyholders mid-contract that it was changing the network the consumer had signed up for.

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