Georgia Insurance and Safety Fire Commissioner John King on Tuesday announced a stiff fine for Blue Cross Blue Shield for multiple violations of state law and other “serious issues.”
The insurance provider will be forced to pay $5 million, following a months-long investigation by the state agency.
“As Georgia’s Insurance Commissioner, my number one priority is protecting Georgia consumers,” said King. “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.”
According to the agency’s findings, the carrier often produced an inaccurate list of “in-network” health care providers. Therefore, when individuals filed what they believed to be an in-network claim, they were processed as out-of-network, forcing the individual to fully pay for the services.
“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,” continued King. He said that the fine may carry “potential additional penalties if certain benchmarks are not reached.”
If Blue Cross Blue Shield does not meet certain corrective benchmarks that were mutually agreed upon, the company may be forced to pay even more in fines. To avoid this, it must “develop a new process for handling regulatory provider complaints, pay claims within the timeframes established under state law, and load provider contracts in a timely manner.”
In a press conference detailing the decision, King noted this is the largest fine ever handed down by the agency.
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Cooper Moran is a reporter for The Georgia Star News and The Star News Network. Email tips to [email protected].
Photo “Blue Cross Blue Shield of Georgia” by Baston-Cook Construction.
