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Life Health > Health Insurance

CDI discovers over 700 claims violations at Anthem

By Staff Writer

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More bad news for Anthem Blue Cross. Attention has been focused on the California-based WellPoint subsidiary after announcing it would raise health care rates by as much as 39 percent next month. Now, the company is facing the ire of the state insurance department. California Insurance Commissioner Steve Poizner announced Monday that an investigation of the company’s claims handling process uncovered over 700 violations of state law.

“When consumers pay their premiums every month, they expect insurance companies to uphold their part of bargain and pay claims quickly, correctly and comply with all other legal requirements,” Commissioner Poizner said in a statement.

Failures to pay claims within 30 days and other delays made up the bulk of the violations, as well as failure to respond to requests for information from the CDI.

“From a failure to respond when the Department of Insurance requested information to investigate complaints to misrepresenting the facts to consumers, these are serious violations and if they are proven in the enforcement action, Anthem Blue Cross will be held liable for them,” Poizner added.

CDI’s release specifies Anthem’s indiscretions.

  • Failure to pay claims in 30 days – 277 violations
  • Failure to respond to the CDI in reasonable time so we can investigate complaints – 143 violations
  • Miscellaneous delays and other claims handling violations – 178 violations
  • Misrepresenting facts or policy provisions to insureds – 66 violations
  • Failure to pay Interest on unreimbursed claims – 25 violations
  • Unreasonably low settlement offers – 22 violations
  • Failure to pay or contest a claim within 30 days – 21 violations

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