Commentary

What Blue Cross needs to do to rebuild its reputation after $3.6M fine

Blue CrossYesterday afternoon, the North Carolina Department of Insurance (DOI) announced that it fined Blue Cross and Blue Shield of North Carolina (BCBSNC) a record $3.6 million for its customer service failures, which were brought about by technological problems the company experienced earlier this year. Prior to issuing the fine, DOI received thousands of formal complaints in which North Carolinians from across the state noted:

…that BCBSNC customer service department was not readily available by telephone or through their website; that consumers did not receive valid identification cards or proof of coverage; that consumers experienced problems in billings and crediting of premium payments; that consumers experienced incorrect policy cancellation notices and difficulty obtaining premium refunds due; and that consumers did not receive timely notices of renewal of their policies with explanations of coverage changes.

In the agreement it signed with DOI, the nonprofit insurance company acknowledged it fell short of expectations, noting that it “…failed to timely provide identification cards, experienced errors in invoices and billing, and failed to respond to the NCDOI on a timely basis in early 2016,” which resulted in disruptions for thousands of consumers across the state. BCBSNC has attributed these problems to technology failures that the company claims have been corrected.

DOI did the right thing by levying this fine, signaling that there are consequences when an insurer makes mistakes that jeopardize consumers’ health and finances. Although the Department has concluded its investigation into BCBSNC, there are actions that the company can take to ensure that it does right by the people of North Carolina. Clearly, Blue Cross must ensure that its IT systems are indeed problem-free in advance of the next Marketplace Open Enrollment Period starting on November 1, 2016.

But the most important thing that Blue Cross and Blue Shield of North Carolina can do to honor its commitment to the people of this state is to serve North Carolinians in all 100 counties of the state on the Health Insurance Marketplace in 2017. In comments made last week, CEO Brad Wilson hedged when asked whether the company would do so next year, citing concerns about health care costs and onboarding customer service staff. But given that the ACA business is a relatively small part of the company’s overall portfolio and that the company was deemed “profitable” and in good financial health last year, BCBSNC ought to do the right thing.

After all, Blue Cross and Blue Shield of North Carolina’s mission is “[t]o improve the health and well-being of our customers and communities.” If they truly want to improve the health of our communities, they’ll prepare to serve all of our communities.

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