Blue Cross to pay $1 million over complaints

BILLINGS (AP) — Blue Cross Blue Shield of Montana will pay $1 million under an agreement announced Thursday to avoid legal action from regulators who received hundreds of complaints over the company’s services.

Half the money will go into Montana’s general budget, and the other half to the Center for Mental Health Research and Recovery.

The company, which serves 243,000 customers in Montana, chalked up the complaints in part to changes within the insurance industry because of federal health care reform.

Thursday’s agreement with state Insurance Commissioner Monica Lindeen calls for Blue Cross to improve services through steps such as establishing a Montana-dedicated call center. Failure to maintain those services would subject the company to penalties of up to $75,000 per calendar quarter.

About 300 complaints were received. They included the company failing to respond in a timely manner to insurance claims, failing to correctly calculate deductibles and failing to provide customers with documents such as insurance cards.

As part of the agreement with Lindeen, Blue Cross also must meet six specific performance benchmarks for services.

Those range from answering telephone calls within a few minutes to processing health care claims within 30 days for most customers.

Lindeen said in a statement that when people spend money on health insurance, “you expect to have your medical claims paid.”

Blue Cross spokesman John Doran says the company has acknowledged and resolved many of the issues that prompted the commissioner to step in.

He said claims were being processed much more quickly than earlier in the year, with 97 percent now being processed within 30 days.

Besides the changes brought on by the passage of President Barack Obama’s Affordable Care Act, Doran said the company had converted to a new information technology system since it became part of the Health Care Service Corp. of Chicago.

“In our nearly 75 years of doing business in Montana we have never before seen this degree of change all at once,” he said.

Blue Cross last year reimbursed more than $700,000 in erroneous charges following a separate investigation by Lindeen’s office into deductibles charged by the company.  

The company also was fined $5,000.