State fines Blue Cross Blue Shield of Illinois for failing to properly update provider directories

Illinois state capitol building
Illinois state capitol building(KWQC Staff)
Published: Nov. 3, 2023 at 4:35 PM CDT
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CHICAGO (WGEM) - The Illinois Department of Insurance (IDOI) announced Friday fines totaling $231,900 for Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, for violations of the Network Adequacy and Transparency Act (NATA) requirements for health insurers to post up-to-date, accurate, and complete provider directory information.

According to state officials, earlier this year, following a targeted market conduct examination of Blue Cross Blue Shield of Illinois, the Department fined HCSC for violating NATA and ordered the company to take corrective action, including updating provider directories and making the information clearer to consumers.

“Consumers rely on their health insurance companies to provide accurate information, so that they can make important, informed decisions about their health care,” said Dana Popish Severinghaus, IDOI Director. “Provider directories are often the first touchpoint for health insurance consumers attempting to choose a primary care physician or specialist. Inaccurate, outdated, confusing information can make that selection process even more time-consuming and stressful. In Illinois, health insurers with provider directories found to be in violation of the law will be fined.”

The $231,900 fine for Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, is for violating:

  • The Network Adequacy and Transparency Act (NATA) requirement for insurers’ provider directories to be updated within 10 business days with any information or status updates. HCSC was in violation of this requirement for 4 providers.
  • Order 10 of the Director’s Market Conduct Stipulation and Consent Order executed January 30, 2023, to institute corrections to the provider directory consistent with 215 ILCS 124/25(a)(6) and 45 CFR § 156.230(b)(2)(ii) within 90 days.

Blue Cross and Blue Shield of Illinois released the following statement on Friday:

According to state officials, HCSC is now complying with the earlier Director’s Order, including:

  • Creating an improved search process within its provider directories so that consumers can more easily find providers for their particular plan and health care needs, and within their geographical area. The improved search includes more distinct naming of plans, fewer acronyms, and the use of zip code specificity.
  • When a consumer selects their particular plan, the consumer can search by specialty type and/or diagnosis to find the right provider for their health care needs.
  • When a list of providers is shown to the consumer, a new filter will highlight the providers’ up-to-date and verified information including, telehealth services, the providers’ acceptance of new patients, location, phone number and other information.
  • For providers who are in-network for facility or hospital admitting rights only, those providers will no longer show in specific health plans to avoid confusing consumers who are searching for doctors and specialists available for in-office visits. The providers with limited access will be listed in the All Plans/All Providers section.

This fine follows a series of regulatory actions by the Department to protect Illinois health insurance consumers under the Network Adequacy and Transparency Act (NATA).

  • Last year, the Department announced, for the first time, a fine for violation of NATA.

The company was fined for failing to file material change notices.

  • The Department also established regulations strengthening network adequacy protections by setting patient-to-provider ratios, time and distance standards, and reporting requirements.
  • Gov. Pritzker’s fiscal year 2023 budget authorized and funded additional headcount for the Department to form a NATA enforcement unit. The new unit investigates insurer networks, and that unit was instrumental in investigating provider directory issues, including reviewing underlying contracts and identifying real-time violations.

IDOI will conduct follow-up exams to ensure HCSC remains in compliance.

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