Tracker Pixel for Entry

​Blue Cross Blue Shield fined by state Insurance Department

by C.S. Hagen | .(JavaScript must be enabled to view this email address) | News | July 9th, 2019

Blue Cross Blue Shield of North Dakota building - photograph by C.S. Hagen

FARGO – A yearlong conduct investigation by the North Dakota Insurance Department into Blue Cross Blue Shield of North Dakota resulted with a fine of $125,000 for the insurance company.

The North Dakota Insurance Department looked into Blue Cross Blue Shield of North Dakota’s company operations, insurance fraud reporting, violations on policy form filing laws, failing to process coordination of benefits claims correctly, corporate governance, complaints, mental and behavioral health and substance use parity, denying claims for mental and behavioral health and substance use, telehealth, and benefits with automobile insurance, among other issues, according to a report filed by Jon Godfread, the North Dakota Insurance Commissioner.

“The results of the market conduct examination report of Blue Cross Blue Shield of North Dakota made it clear that some important changes need to be made to the way they do business,” Godfread said. “Blue Cross Blue Shield of North Dakota has committed to me that they will immediately begin working to fix the issues found during the examination. I have already seen positive actions taken by the company since the Department identified these issues.”

Godfread’s examination found deficiencies in how Blue Cross Blue Shield of North Dakota processes mental health and substance abuse claims, and that the company’s preauthorization process was not in compliance with the law.

“As our largest health insurance carrier, many North Dakotans rely on Blue Cross Blue Shield of North Dakota to obtain access to mental health and substance abuse treatment,” Godfread said. “The issues we have identified in this examination are being immediately addressed and corrective action is being taken to make sure addiction and behavioral health services are being covered appropriately.”

The examination – which pooled information from June 1, 2013 to February 28, 2018 – also found that the company was not allowing for independent external reviews for grandfathered plans, failed to provide telehealth services in accordance with the law, violated policy form filing laws, failed to process coordination of benefits claims correctly, and failed to report acts of suspected insurance fraud to the Department as required by law.

In addition to the fine Blue Cross Blue Shield of North Dakota, which is the state’s largest health insurance carrier, the company also agreed to invest more than $300,000 internally to address issues the investigation uncovered.

“Blue Cross Blue Shield of North Dakota is thankful for the efforts of the North Dakota Insurance Department and the collaborative nature in which it conducted this comprehensive market conduct examination,” Tim Huckle, president and CEO of Blue Cross Blue Shield of North Dakota, said. “As with every examination, Blue Cross Blue Shield of North Dakota appreciates the opportunity to learn about the ways we can enhance our internal operations in this evolving environment. The health insurance industry continues to grow significantly more complex and this review reveals that we can do more to ensure its compliance in this highly regulated environment.”

Blue Cross Blue Shield of North Dakota was founded in 1998 after converting into a nonprofit mutual insurance company. The organization originally began in 1940 as the North Dakota Hospital Services Association, then merged in 1986 with the North Dakota Physicians Service.

Since 2014, the organization’s written hospital and medical health premium amounts have decreased from more than $1 billion in 2014 to $744,125,585 in 2017. Enrollment has also decreased from 431,765 in 2014 to 318,734 in 2017.

During the course of the North Dakota Insurance Department’s investigation they discovered that out of 1,266 cases of insurance fraud Blue Cross Blue Shield of North Dakota reported, only 518 cases were actually suspected cases, according to the report. An additional 13 insurance fraud cases the company failed to report were also uncovered.

During the investigation’s course the company attributed many of its internal management problems to high turnover rates, fading memories, and sometimes allowed claims to be paid, which were later denied.

Blue Cross Blue Shield of North Dakota also lacked regulatory oversight and controls of its website operations concerning Medicare Supplement applications, according to the 22-page report.

The company also failed random sample testing for 2,143 of its denied preauthorization for mental health and substance use disorders and 9,865 of its denied claims for mental health and substance use disorders.

In response to the investigation’s results, Blue Cross Blue Shield of North Dakota has begun drafting Corrective Action Plans, or CAPs, to address the problems, according to the report.

Consumers with questions about the claims process or how they are being covered are encouraged to contact the Department at (701) 328-2440 or send emails to insurance@nd.gov.

RECENTLY IN

News

Tracker Pixel for Entry TAKAPRIL4 Tracker Pixel for Entry HarborHealthClinic Tracker Pixel for Entry HPR Sales Tracker Pixel for Entry HPRONLINE

Recently in:

News

​Man and the moon

by C.S. Hagen

VALLEY CITY – Lowell Busching shuffled into The Vault, pointed to the staff-less counter featuring self-serve sandwiches, Kuchen, and coffee before launching into a history of the building, once a bank. Books and magazines are…

You probably won’t be connecting an Ethernet cable to your smartphone anytime soon. But it’s usually worth running Ethernet cables to the devices that matter, if you can—gaming and media PCs (or consoles), backup devices, and…

Thursday, July 25, 6:30-8:30 p.m.Zandbroz, 420 N Broadway, FargoAuthor Sarah Coomber will be making an appearance at Zandbroz for a reading and signing of her recently released memoir, "The Same Moon." Recently wed and soon…

It’s no secret Theodore Roosevelt loved North Dakota. It’s also no secret North Dakotans love Teddy. He left us with a legendary legacy and it’s no wonder that the Theodore Roosevelt Presidential Library will be in the…

Gadfly

​Freedom???

by Ed Raymond

There Seems To Be A Lot Of Confusion About What Freedom Is!At a recent conference of the evangelical Christian’s Faith and Freedom Coalition, Chairman Ralph Reed, long a hard worker for the Moral Majority’s Jerry Falwell, had…

To say that this year’s Bartenders Battle was the best display of talent in the six years since its creation would be an understatement and a disservice to not only the bartenders who made it into the competition, but also the…

By Teresa Farrelltara.Ekren@essentiahealth.orgLove it or hate it, it’s rhubarb season! Rhubarb brings back good memories for me.Growing up on the family farm, my siblings and I would head outside with a bowl of sugar, snap off…

High Plains Reader had the opportunity to catch up with Sarah Shook, front woman of the North Carolina based punk country band Sarah Shook and the Disarmers. We had a chance to talk about life and love from the road, where she…

Legendary British skipper Tracy Edwards, who in 1989 led the first all-female crew of sailors to compete in the tough-as-nails, 33,000-mile Whitbread Round the World Yacht Race, makes for a convincing heroine in filmmaker Alex…

Arts

‘Local American epics’

by Sabrina Hornung

The US Postal Service recently released a set of stamps celebrating the New Deal era post office murals that were federally commissioned during the Roosevelt administration, though the mural that graces the walls of the New…

The annual mainstage summer musical, produced by Trollwood Performing Arts School and sponsored by Bell Bank, opens Thursday, July 11. This year’s performance is Disney’s “Freaky Friday.” Trollwood Performing Arts…

Stand-up comedy is traditionally a one-way exchange. Outside of the odd question addressed to a random audience member, the limit of the spectators’ contribution to the conversation is their laughter at the comedy stylings being…

If you’re from the region you may have sipped, sampled or caught word of a libation often referred to as “red eye” or “wedding whiskey” at some point. In fact some of our friends of German Russia descent swear by it. If…

Wellness

Yoga on the Farm

by Ryan Janke

Every Thursday evening during the month of June, Mara Solberg is inviting people to come out and try Yoga on the Farm. It is a unique yoga experience that was born from an idea that was proposed to Solberg.“I’ve been with Red…

by Devin Joubertdevinlillianjoubert@gmail.comIt’s that beautiful time of the year that’s filled with seasonal decorations, sparkly lights, warm family gatherings, and delicious feasts. I love everything about this time of the…

Woman is born free and lives equal to man in her rights…The purpose of any political association is the conservation of the natural and imprescriptible rights of woman and man; these rights are liberty, property, security, and…