August 24, 2016
OLYMPIA, Wash. – Washington state Insurance Commissioner Mike Kreidler has fined Regence BlueShield and Asuris Northwest Health $750,000 for violations of insurance regulations that created issues with consumers’ access to services between January 2010 and June 2011.
Kreidler’s office identified a number of issues during a multiyear examination of the companies’ practices and records:
- Mishandling consumer complaints and use of a restrictive definition of complaint when tracking consumer calls. The exam found the companies categorized a consumer inquiry as a complaint only if the consumer used the word “complaint” in the conversation.
- The companies misplaced records related to three consumers’ complaints.
- Technical issues delayed payments to medical providers for consumers’ claims.
- The companies were unable to track the number and amount of payments they made to each medical provider.
- The companies delayed progress of Kreidler’s examination because of issues in gathering data.
- Use of uncertified Spanish-language translations in documents resulted in inaccurate or unclear information for consumers.
Regence and Asuris worked with Kreidler’s office to resolve the issues during an audit process that addressed the examination findings. The companies agreed in a consent order to pay the fine in full by Sept. 22, 2016. The money will be sent to the state’s general fund.
Regence BlueShield bought Asuris in 1994 and both companies are owned by Cambia Health Solutions, an Oregon nonprofit public benefit corporation and holding company.
The fine is the second-largest that Kreidler’s office has levied since 2007. Other notable fines include:
- $1 million against Aetna in January 2013; order 12-0197
- $534,000 against Chubb Cos. in February 2011; order 11-0009
- $500,000 against BCS Insurance Co. in November 2012; order 11-0247
- $400,000 against Pacificare of Washington, Inc. in November 2012; order 09-0010
- $300,000 against National Union Fire Insurance Co. in June 2015; order 13-0091
Since 2001, Kreidler's office has assessed $20.4 million in fines against insurance companies and professionals found in violation of applicable laws. The money is deposited in the state's general fund to pay for other state services.
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