North Carolina Insurance Commissioner Wayne Goodwin is seeking evidence that could support a $1,000 a day fine against one of the state’s leading health insurer.
Goodwin announced Wednesday that problems with Blue Cross and Blue Shield continue, prompting more than 8,700 calls and 1,900 formal complaints to be filed with the department. Enrollment and billing issues are particularly troubling to both agents and consumers, and Goodwin estimates the issues have created a workload equivalent to nine months in the past nine weeks.
The commissioner is particularly troubled by 70 “priority cases” on which his department intervened, only to have them reopened due to ongoing troubles with the insurer.
“I am looking for every finable violation that I can find,” Goodwin said. “I am looking at the entire arsenal of solutions that I can deploy.”
The comments come as Goodwin continues his investigation of the not-for-profit Blue Cross. He hopes to compile all violations cited in complaints in order to calculate financial penalty of up to $1,000 a day per violation under state law.
The problems stem from Blue Cross attempting to transfer about 400,000 customers on individual insurance policies from a legacy software system to a new billing and enrollment software known as Facets or Topaz.
Since the transfer, customers have been double-billed, overbilled, unenrolled or enrolled on the wrong policies. Blue Cross says the administrative problems are mostly fixed.
“We apologize for the frustration this has caused and will work closely with the Department throughout its review,” Blue Cross told the News Observer. “Though the majority of issues that many of our members faced are resolved, we recognize that even a small percentage of our 3.9 million customers equals too many people.”
The insurer stressed that call volumes and hold times are “down significantly,” though administration is working to fulfill all consumer expectations.
Goodwin has characterized this approach as “slow progress” and said the issues should have been resolved by now.
He is asking consumers and agents to volunteer any information that might aid his efforts.
