Regulators Have Not Reinstated Coverage in Improper Cancellations

More than a year has passed since an investigation by the Department of Managed Health Care found that Blue Cross of California -- now called Anthem -- had illegally canceled health insurance policies for 90 members, but the agency has not ordered Blue Cross to reissue the policies, Capitol Weekly reports.

At a Senate Health Committee hearing last week, DMHC chief of enforcement Amy Dobberteen said the Blue Cross survey aimed to identify "system failures," not review individual cancellation cases.

The department has the authority to require health plans to reissue coverage to members if it finds that their policies were wrongfully canceled. However, Dobberteen said, "The statue does not require reinstatement."

DMHC Director Cindy Ehnes noted that "remedial action remains to be determined" in the Blue Cross cases and other cancellation cases being reviewed by the department.

Senate Health Committee Chair Sheila Kuehl (D-Santa Monica) said conducting systematic reviews without reinstating insurance for individuals whose cases were examined "seems like a major omission."

Anthony Wright, executive director of the patient advocacy group Health Access, said systematic changes, as well as individual remedies are necessary.

Los Angeles City Attorney Rocky Delgadillo has filed a civil law-enforcement class-action suit against Health Net for allegedly illegally canceling individuals' policies. He said, "The regulators should exercise the full extent of their regulatory authority," adding, "If they decline to seek reinstatement of wrongfully canceled policies, then I think it is the job of a prosecutor to seek that very remedy" (Howard/York, Capitol Weekly, 4/3).