Blue Cross Blue Shield Issued $250,000 Fine by Montana Insurance Commissioner [AUDIO]
Spokeswoman for State Insurance Commissioner Monica Lindeen, Jennifer McKee, said the fine was levied as a result of an examination into the company's operations.
"Blue Cross Blue Shield, now known as Caring for Montanans, Inc. was fined for a market exam and the money was paid last week," McKee said. "This fine grew out of what is called a market conduct exam, something the commissioner's office conducts every five years or so. In this case, investigators found some areas where the company was not in compliance with the law, and, hence the $250,000 fine."
All insurance exams measure a company's performance against a long list of standards, most spelled out either in Montana insurance statutes or administrative rules. They range from how the company pays commissions to its agents, to how it handles customer complaints or appeals of denied claims.
The exam stated that the company was applying out-of-network costs for emergency room care, in violation of state law. Also, the company failed to keep certain records that would have allowed examiners to determine if the company was following state law.
McKee said the action against Blue Cross Blue Shield actually was decided over a month ago.
"The reason you're just hearing about it now is because we are required by law to keep it confidential for 30 days," McKee said. "The company chose not to appeal it, and paid the fine. As a result, the company has improved their reporting policies so that the same violations won't happen again. I think a lot of those things have already changed."
Insurance Commissioner Spokeswoman Jennifer McKee