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WA Insurance Commissioner fines Regence BlueShield, Asuris $750,000

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The 750 thousand dollar fine levied by the Insurance Commissioner against Regence is one of the largest in the office’s history.

The state’s audit began when it was flooded with hundreds of complaints about the health insurance giant.

“It took us a while for us to figure out what they are doing because we couldn’t get good information from Regence as to what they are doing and the nature of the complaints we were getting”, said Insurance Commissioner Mike Kreidler.

KIRO 7 also obtained the Market Research Examination of Regence.

It found deficiencies and issues with complaint and claims handling practices.

Kreidler said, “There would be a situation where they would be drawing money out of a person’s account turns out it was the wrong account that was having money drawn out of it.”

Kreidler says handling complaints was especially troublesome for the insurer.

“Because they set up the parameters for complaints to say if you didn’t have the word complaint in the complaint you were filing we wouldn’t consider it a complaint. So we wound up with more it never happens that way. We were getting more complaints than Regence did.

But I wanted to know why this audit took so long. The time frame of it centers on data obtained from 2010 to 2011.

Kreidler blamed the insurer for the delays, “Biggest problem we had, we couldn’t get the information from Regence.

In a statement Regence says-

We take customer service seriously and none of our members were denied access to health care during this time. Once discovered we took immediate action, collaborated with the OIC on an extensive audit, and take full responsibility for any inconvenience this caused.

Kreidler agrees fixes have been made, but his office will keep its eye on Regence’s business practices.

“Regence and my office has worked very closely over the last couple of years to make sure what we saw and what we were monitoring will not be replicated going forward.

This fine is part of a consent order. In other words an agreement between the parties. Regence says it will play by the rules and the insurance commissioner will make sure they do.

This is not a criminal complaint.

Regence says it made the necessary changes four years ago.

Statement from Regence:

First and foremost we want to ensure our customers know that these temporary service issues were resolved in 2012 and were the result of a complex technology upgrade in 2010.

We take customer service seriously and none of our members were denied access to health care during this time. Once discovered we took immediate action, collaborated with the OIC on an extensive audit, and take full responsibility for any inconvenience this caused.

These issues were resolved four years ago and we are disappointed by the OIC’s decision to levy a fine of this size at a time when consumers are already navigating significant changes in the healthcare system. Our current operations are strong and we are consistently recognized for operational and best-in-class service excellence. Nothing is more important to us than providing high quality, cost effective care to the 1.1 million people we serve in Washington state.  

 

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