CALIFORNIA – The California Department of Managed Health Care (DMHC) announced December 16, that they fined Blue Cross of California (Anthem Blue Cross) $3.5 million for failing to handle health plan member complaints in a timely manner.
This fine underscores the importance of accountability among health insurers in adhering to state laws and protecting consumer rights.
Anthem Blue Cross sent over 11,000 complaint response letters late
The DMHC launched an investigation after the company reported that it was often late in sending out letters to acknowledge and resolve complaints.
California law says health plans must let people know they received their complaint – or grievance, within five days.
The Department found that between July 2020 and September 2022, Anthem Blue Cross sent over 11,000 late complaint response letters. Some were more than 51 days late, and over 3,600 weren’t sent at all.
Anthem Blue Cross admitted they broke the rules and paid the $3.5 million fine. They also said they’ve made changes to fix their complaint process, like adding more training and better procedures to handle complaints on time.
Fines support physicians who serve Medi-Cal patients
According to the DMHC, fines like the $3.5 million paid by Anthem Blue Cross are deposited into the Managed Care Administrative Fines and Penalties Fund. This fund supports the Medically Underserved Account for Physicians, which provides financial assistance to physicians who serve Medi-Cal patients.
What members can do
The DMHC encourages health plan members experiencing issues with their health plan, including denials, delays or modifications of requested health care services, to file a complaint with their health plan.
If the member does not agree with their health plan’s response or the plan takes more than 30 days to respond, the member should contact the DMHC Help Center. If a health plan member is experiencing an urgent issue, they should contact the DMHC Help Center immediately.
Health plan members can file a complaint or apply for an Independent Medical Review with the DMHC Help Center at www.DMHC.ca.gov or by calling 1-888-466-2219.
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