BCBS to Pay $1M to Resolve Hundreds of Complaints

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‘When you spend hard earned money on health insurance, you expect to have your medical claims paid.’

HELENA, Mont. – Blue Cross Blue Shield of Montana will pay $1 million in response to hundreds of customer complaints handled this year by Montana Insurance Commissioner Monica J. Lindeen and her office.

The complaints against BCBS fell into a broad range of categories, including: failing to calculate deductible payments or calculating such payments incorrectly, failing to process medical claims in a timely manner, failing to respond to Lindeen’s office when regulators attempted to resolve issues in early 2014, failing to record the payment of customers’ monthly bills and failing to provide customers with needed documents, including insurance cards.

In the first half of this year alone, Lindeen’s office fielded three times as many complaints against Blue Cross Blue Shield than the office saw in the same period last year.

“When you spend hard earned money on health insurance, you expect to have your medical claims paid,” Lindeen said. “My office is here to ensure all health insurance companies live up to their obligations. Montanans deserve no less, especially those who are dealing with the emotions and stress of serious health issues. I appreciate BCBS’s willingness to work with me to correct their mistakes and develop a plan to better serve Montanans.”

Half of the $1 million will go to the Center for Mental Health Research and Recovery at Montana State University in Bozeman. The Center launched in October with the aim of providing better diagnosis and treatment of mental illness throughout Montana. It will be the Center’s first contribution.

The other half will go to the Montana general fund, or treasury, as an administrative penalty payment.

In addition, the company has agreed to improve customer service, including designating 50 of their most experienced customer service representatives to help Montanans. The company has also agreed to, among other things; guarantee that at least half of the Montanans who call with an insurance problem will have their problem fixed after the first phone call. Previously, some Montanans made repeated phone calls over many weeks before their problems were resolved. Many of those problems were not resolved without intervention from Lindeen’s office.

If the company fails to make the required changes, it will face additional penalties.

The entire agreement is spelled out in a legal document signed today by both Lindeen and BCBS. The agreement resolved potential legal action against the company by Lindeen’s office.