Blue Cross Blue Shield of Illinois pays $605K fine for violating state transparency rules

Blue Cross Blue Shield
Blue Cross Blue Shield(MGN)
Published: Mar. 10, 2023 at 11:21 PM CST
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(25News Now) - The Illinois Department of Insurance (IDOI) has fined Blue Cross Blue Shield of Illinois’ parent company for breaking a state law about transparency.

Parent Company Health Care Service Corporation (HCSC) has paid the $605,000 fine and agreed to take corrective measures to comply with the Network Adequacy and Transparency Act (NATA), the state said in a news release.

IDOI’s targeted market exam for network advocacy, starting Nov. 2, 2020 and posted on Thursday, revealed the following NATA violations.

• Failed to properly apply maximum time and distance standards to reflect proper availability of providers.

• Failed to audit for each network plan at least 25% of its provider directories to verify the accuracies of the provider directories.

• Failed to list all available specialty providers for HMO plans in its provider directories or notate that authorization may be required to access some providers.

• Failed to make its provider directories clear for consumers to determine which directory applies to which plans.

• Failed to provide a written response to written inquiries and complaints within 21 days of receipt.

• Failed to provide accurate and most up-to-date network adequacy information in its SERFF filings to the state.

• Failed to maintain provider information on its website to reflect the current status of its providers.

IDOI Director Dana Popish Severinghaus released a statement.

“We are committed to ensuring that Illinois consumers have access to care and receive equitable service from the health insurance companies collecting their monthly premiums. The law requires health insurance companies to have a provider network that meets proper time and distance standards for consumers to receive care, as well as up-to-date, accurate directories identifying which providers are in-network. When companies under our regulatory authority are in violation of insurance laws meant to protect consumers, we will take action.”

IDOI intends to conduct follow-up exams to make sure the company continues to comply with the law.