Department of Managed Health Care announced Tuesday it issued a $415,000 fine against Anthem Blue Cross for not responding to customer grievances
The department found 40 cases involving 83 violations where Anthem deprived its customers of grievance and appeal rights. The department also cited Anthem for failing to identify, process and resolve grievances. It also cited Anthem for failing to provide timely information to the department during the investigation of complaints.
Under state law, health plan members have the right to know why a health plan has denied a procedure, treatment or service. Members have a right to file a grievance if they disagree with the insurer, and they have the right to file a complaint and request an independent medical review from the DMHC.
The department is mandating Anthem provide a detailed report in 90 days that analyzes how the insurer is identifying and correcting violations.
“The DMHC is committed to protecting the health care rights of Californians,” said Shelley Rouillard, DMHC director, in a news release. “Health plan members have many health care rights, including the right to file a grievance. The grievance process is fundamental to ensuring members receive needed health care services with their health plans.”
Anthem spokesman Darrel Ng said the insurer is taking steps to address the violations.
“In order to resolve the issues identified by the Department of Managed Health Care, Anthem has provided additional training to its staff and implemented a new tracking system to reduce delays with the grievance and appeals system,” Ng said.
Date: May 4, 2016