Georgia's insurance commissioner has fined Blue Cross Blue Shield $5 million for violations of state laws and agency rules and regulations, the commissioner's office said March 29.
Below is the statement of the Insurance and Safety Fire Commissioner, John F. King -
“As Georgia’s Insurance Commissioner, my number one priority is protecting Georgia consumers,” said Commissioner King. “To that end, after numerous complaints made to our office regarding the operations of Blue Cross Blue Shield from individuals, physicians, hospitals, and others from around the state, I instructed my staff to conduct an extensive examination into the carrier’s practices.”
“This examination uncovered a number of serious issues, including improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories, and significant delays in loading provider contracts,” continued King. “As a result, our office has issued the largest fine in Agency history, with potential additional penalties if certain benchmarks are not reached.”
BCBS must develop a new process for handling regulatory provider complaints, pay claims within the time frames established under state law and load provider contracts in a timely manner. The company may face additional fines if it misses certain benchmarks in the corrective action plan.