Insurance Commissioner Fines Former Blue Cross

By Beacon Staff

HELENA — The former Blue Cross Blue Shield of Montana has paid a $250,000 fine for violations uncovered during an audit completed last summer, Montana Insurance Commissioner Monica Lindeen said Thursday.

The “market conduct exam,” completed last summer, revealed the company had a business practice until late 2010 of processing some emergency care claims at the out-of-network co-insurance rate of 40 percent, rather than 50 percent rate listed in the policy, unless the insured filed an appeal. Click here to read the report.

The audit also found that Blue Cross Blue Shield entered into an agreement with an association in April 2009 in which the bills it sent to employer groups also included the costs of an association member life insurance policy, an employee-assistance program and an administrative fee. Blue Cross Blue Shield returned the extra money to the association, but reported it as a commission.

State law requires premiums for each type of insurance to be billed separately.

The exam also found Blue Cross failed to retain required records that would have allowed examiners to determine if the company was following state law.

The fine was paid to the state general fund by Caring for Montanans Inc., which was created to manage the remaining assets of the former Blue Cross Blue Shield organization.

In paying the fine, the nonprofit company did not acknowledge any wrongdoing.

Jerry Lusk, chairman of the board for Caring for Montanans Inc., declined to comment to the Beacon early Thursday about the audit and subsequent fine. When asked if the organization was aware of any of the violations before the final report was released last month, Lusk replied, “No comment.”

Blue Cross Blue Shield of Montana’s alliance with Health Care Service Corp. was completed in August 2013. The new company has not been involved in the market conduct exam or its findings, spokesman John Doran said. He notes the market-conduct examination report relates to the old company’s operations and practices from 2006 through 2010.

Doran issued a statement to the Beacon on Thursday:

We participated in the market conduct exam only up until August, when the alliance with Health Care Service Corporation (HCSC) was completed. Since then, Blue Cross and Blue Shield of Montana (BCBSMT) has not been involved in the exam or its findings. This has been the responsibility of Caring for Montanans, Inc., the old company that remains as a result of the alliance between HCSC and BCBSMT.

It is important to note that the findings in the market conduct examination report relate to Caring for Montanans’ operations and practices for the period 2006 through 2010. Accordingly, we are not in a position to comment on the report.

An email seeking comment from Chris Manger with Caring for Montanans was not immediately returned late Thursday afternoon.

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