State Fines Anthem Blue Cross $415K For Ignoring Consumers’ Grievances
The Department of Managed Health Care found 40 cases involving 83 violations where Anthem deprived its customers of grievance and appeal rights.
KPCC:
California Fines Anthem Blue Cross For Violating Customers' Grievance Rights
The Department of Managed Health Care said Tuesday that it has fined Anthem Blue Cross $415,000 for violating some of its health plan members' grievance and appeal rights. The penalty levied against Anthem Blue Cross involved 83 violations in 40 cases. They include failure to adequately consider and resolve an enrollee’s grievance; failure to resolve a grievance within the 30-day time frame set forth under state law; failure to adequately explain the reason for denying treatment; and failure to respond in a timely fashion to Managed Health Care's investigation. (O'Neill, 5/3)
The Sacramento Business Journal:
Anthem Blue Cross Fined For Ignoring Consumer Rights
Under state law, health plan members have the right to know why a health plan has denied a procedure, treatment or service. Members have a right to file a grievance if they disagree with the insurer, and they have the right to file a complaint and request an independent medical review from the DMHC. (Anderson, 5/4)
California Healthline:
Anthem Blue Cross Fined For Poor Handling Of Consumer Grievances
The agency said Anthem must provide a detailed report within 90 days on the actions it has taken to fix these violations. “The DMHC is committed to protecting the health care rights of Californians,” said Shelley Rouillard, the agency’s director. “The grievance process is fundamental to ensuring members receive needed health care services with their health plans.” Darrel Ng, an Anthem spokesman, said the company is paying the fine and continues to work on resolving the issue. (Ibarra and Terhune, 5/3)