State regulators to examine Blue Cross operations

Published February 12, 2016

[caption id="attachment_1612" align="alignleft" width="150"]Insurance Commissioner Wayne Goodwin Insurance Commissioner Wayne Goodwin[/caption]

by Renee Chou and Laura Leslie, WRAL, February 11, 2016.

North Carolina Insurance Commissioner  said Thursday that his agency is launching an examination of Blue Cross Blue Shield of North Carolina as customers continue to experience problems with the insurer.

The Department of Insurance plans to monitor Blue Cross' compliance with state laws and regulations, according to Goodwin, who met with company leaders this week.

Since the beginning of January, the department has received more than 1,000 complaints from Blue Cross customers about overbilling, inability to verify effective coverage and computer errors that prevent them from paying premiums, Goodwin said.

"We've had more calls in the last four or five weeks than we would have normally in three or four months," he said.

The state's largest health insurer opened the year with about 25,000 customers who were either enrolled in plans they never signed up for or had the wrong amount of money drafted from their bank accounts. Others waited weeks for identification cards to prove to providers that they had health coverage.

The company's customer service center was swamped by thousands of irate calls, leaving many people frustrated and even angrier because they couldn't speak to anyone to get their problems addressed.

Spokesman Lew Borman said Blue Cross will work with the Department of Insurance to correct any lingering problems.

"We apologize for the frustration this has caused and will work with the department throughout its review," Borman said in an email to WRAL News. "Though the majority of issues that many of our members have faced have been resolved, some work remains. We will continue working hard to address our customers’ concerns and deliver the level of service they expect."

Company officials blamed an increase in people enrolling for coverage under the Affordable Care Act in late December and early January for the problems.

Borman said Blue Cross plans to re-evaluate its participation in the online marketplace for Affordable Care Act coverage in 2017, saying it's "a possibility" that the company could stop providing plans through the exchange.

"While the ACA has improved the availability of health care, it has done little to address the underlying costs of care and so far has resulted in skyrocketing premiums," he said. "Consistently losing money on these plans ultimately puts all of our customers at risk. We are doing everything we can to participate in the exchange, but must evaluate the sustainability and affordability of any plans we offer our customers for 2017."

Blue Cross has said that the costs of treating chronic health conditions for large numbers of Affordable Care Act enrollees led to a $50 million loss in 2014 and to premium increases of about 30 percent last year.

Lee Dixon, project director for Get Covered NC, a nonprofit that helps administer Affordable Care Act enrollment in the state, declined to comment on the "hypothetical issue" of Blue Cross pulling out of the marketplace.

Blue Cross is the only insurer that provides health plans through the online marketplace in all 100 North Carolina counties – UnitedHealth and Aetna's Coventry Healthcare provide plans in parts of the state – and it accounts for more than half of the 613,000 enrollments under the Affordable Care Act statewide.

"What we’re more concerned about is what we’re hearing from our coalition partners across the state and the concerns we have for consumers trying to access their health insurance," Dixon said. "These are people who have insurance, and they’re trying to pay for their insurance after having enrolled. We want to make sure that, since they have enrolled, they can pay their premiums, get their enrollment cards, see their doctors and get their prescriptions filled."

Goodwin said the state cannot make Blue Cross offer marketplace plans, so he urged the General Assembly to reconsider setting up a state exchange, which would give him more flexibility and more oversight of the Affordable Care Act in North Carolina.

"Our marketplace could have avoided many of the hiccups and concerns that we’re facing if we had greater control over our health insurance destiny," he said. "I’m trying to help consumers because, if we don’t have an answer to the questions I’ve raised, then we may have North Carolinians who have health insurance for the very first time who then become uninsured, and we’d go backwards with the enrollment numbers we’ve faced."

Lawmakers should revisit the idea of expanding Medicaid, Goodwin said, noting that would cover many of the highest-cost patients and make it more financially viable for more insurers to compete in the marketplace.

"We need the public to be aware and our elected officials to know that decisions that were made several year ago are now bearing bad fruit in this state, and that's what's happening," he said.


February 12, 2016 at 1:54 pm
Richard L Bunce says:

The State running a better exchange is nonsense... see the other States that tried with mixed results and see NC Medicaid.

The State getting into the BCBSNC business model is nonsense... see most NC business software efforts.

This would all have been so much easier to buy insurance directly from the insurer and then claim the premium tax credit and participation in the Cost Share Reduction programs directly with the government. Keep the finances and the insurance separate.