IL Dept. of Insurance Fines BCBS of Illinois

By Jeremy Coumbes on March 10, 2023 at 12:41pm

A major health insurance carrier has been fined by the State of Illinois. The Illinois Department of Insurance (IDOI) announced today a $605,000 fine has been levied on Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, for violating the Network Adequacy and Transparency Act (NATA).

Insurers are required by law to have a provider network that meets proper time and distance standards for consumers to receive care, as well as up-to-date and accurate provider directories that identify which are considered in-network.

According to the announcement, Blue Cross Blue Shield of Illinois violated NATA and other state and federal laws related to network adequacy including:

Failing to apply maximum time and distance standards to reflect the proper availability of providers.

Failing to audit for each network plan at least 25% of its provider directories to verify the accuracy of the provider directories.

Failing to list all available specialty providers for HMO plans in its provider directories

Failing to make its provider directories clear for consumers to determine which directory applies to which plans.

Failing to provide a written response to written inquiries and complaints within 21 days of receipt.

Failing to provide accurate and most up-to-date network adequacy information in its SERFF filings to the state.

Failing to maintain provider information on its website to reflect the current status of its providers.

The violations were discovered during IDOI’s targeted market conduct exam for network adequacy that was initiated in November 2020 and posted today.

IDOA says that Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, paid the fine and agreed to take corrective action based on the exam findings.

Officials with IDOA say the Department will conduct follow-up exams to ensure the company remains in compliance.