Top WA Health Insurer Racking Up Violations
Washington State Insurance Commissioner Mike Kreidler has ordered the state’s largest health insurer to correct problems that have affected tens of thousands of consumers.
“The Regence Group needs to gets its act together,” Kreidler said. “We’ve seen an ongoing pattern of errors and problems with Regence and its subsidiaries. Many of these problems directly harm consumers and health care providers.”
Among the current problems:
• Regence’s “SurePay” computer system malfunctioned on Aug. 5, 2011, resulting in more than 6,000 incorrect transactions.
• Medical claims from tens of thousands of retirees have gone unpaid for months.
• In more than 200 cases, the company apparently withdrew money from the bank accounts of people who are not even Regence members. Some of the withdrawals totaled thousands of dollars. In the process, some Regence members’ names and identification numbers were accidentally disclosed to strangers.
• Regence’s systems and processes result in after-the-fact denial of claims for many pre-authorized medical services.
• There is a pattern of claims being delayed because documentation has been misplaced by Regence, only to later be found.
• Regence’s underwriting department provided a phone number for consumer questions. When consumers called that number, they would receive a message saying that contact was available only on Thursdays. On Thursdays, there was no answer.
State insurance regulators from Washington, Oregon, Idaho and Utah called Regence Group CEO Mark Ganz to a meeting in Salem, Ore. Sept. 1 to discuss the problems.
The Portland-based company says it is working hard to investigate and correct the problems. Kreidler’s office is working with Regence to develop a mandatory corrective action plan.
“The status quo clearly isn’t acceptable,” said Kreidler. “Many of these things seem to be systemic problems, rather than isolated incidents.”
Regence and its subsidiaries have faced state enforcement actions recently:
• In August, Kreidler fined Regence BlueShield $100,000 for wrongly denying contraceptive claims from 984 women over a period of eight years. The company also paid the claims, which totaled $148,740.
• In September 2010, Kreidler ordered Regence BlueShield, Asuris Northwest Health and Regence BlueCross BlueShield of Oregon to stop wrongly turning down insurance applications for children.
• Also in 2010, Regence BlueShield, Asuris Northwest health and Regence BlueCross BlueShield of Oregon were fined $125,000 for violations, including failing to provide mandated coverage for prostate cancer screenings.
“The Regence Group needs to gets its act together,” Kreidler said. “We’ve seen an ongoing pattern of errors and problems with Regence and its subsidiaries. Many of these problems directly harm consumers and health care providers.”
Among the current problems:
• Regence’s “SurePay” computer system malfunctioned on Aug. 5, 2011, resulting in more than 6,000 incorrect transactions.
• Medical claims from tens of thousands of retirees have gone unpaid for months.
• In more than 200 cases, the company apparently withdrew money from the bank accounts of people who are not even Regence members. Some of the withdrawals totaled thousands of dollars. In the process, some Regence members’ names and identification numbers were accidentally disclosed to strangers.
• Regence’s systems and processes result in after-the-fact denial of claims for many pre-authorized medical services.
• There is a pattern of claims being delayed because documentation has been misplaced by Regence, only to later be found.
• Regence’s underwriting department provided a phone number for consumer questions. When consumers called that number, they would receive a message saying that contact was available only on Thursdays. On Thursdays, there was no answer.
State insurance regulators from Washington, Oregon, Idaho and Utah called Regence Group CEO Mark Ganz to a meeting in Salem, Ore. Sept. 1 to discuss the problems.
The Portland-based company says it is working hard to investigate and correct the problems. Kreidler’s office is working with Regence to develop a mandatory corrective action plan.
“The status quo clearly isn’t acceptable,” said Kreidler. “Many of these things seem to be systemic problems, rather than isolated incidents.”
Regence and its subsidiaries have faced state enforcement actions recently:
• In August, Kreidler fined Regence BlueShield $100,000 for wrongly denying contraceptive claims from 984 women over a period of eight years. The company also paid the claims, which totaled $148,740.
• In September 2010, Kreidler ordered Regence BlueShield, Asuris Northwest Health and Regence BlueCross BlueShield of Oregon to stop wrongly turning down insurance applications for children.
• Also in 2010, Regence BlueShield, Asuris Northwest health and Regence BlueCross BlueShield of Oregon were fined $125,000 for violations, including failing to provide mandated coverage for prostate cancer screenings.
