Illinois Department of Insurance Fines Blue Cross Blue Shield Again for Violation of Network Adequacy and Transparency Act

SPRINGFIELD, Ill. (WCIA) — The Illinois Department of Insurance has fined a major insurance company for failing to update its provider directory in a timely manner.

The state agency previously fined Blue Cross Blue Shield more than half a million dollars in March for violating network adequacy laws. Agency officials say they fined the company an additional $231,900 because Blue Cross Blue Shield delayed implementing changes to its provider directories to address network adequacy violations from the first fine.

Consumers rely on their health insurance companies to provide accurate information, so they can make important, informed decisions about their health care, IDOI Director Dana Popish Severinghaus said in a statement. Provider directories are often the first point of contact for health insurance consumers trying to choose a primary care physician or specialist. Inaccurate, outdated and confusing information can make this selection process even more time-consuming and stressful. In Illinois, health insurers whose provider directories violate the law will be fined.

According to the department, BCBS’s parent company, Health Care Service Corporation, has now improved its directory search processes to now comply with the IDOI Director’s order. IDOI officials say they will conduct follow-up reviews to ensure the company remains in compliance with the Network Adequacy and Transparency Act.

The WCIA Target 3 Investigative Team released a series of investigations into Blue Cross Blue Shield violating continuity of care in spring 2022.

Blue Cross Blue Shield provided WCIA with the following statement in response to the fine:

Blue Cross and Blue Shield of Illinois strive to provide our members with an accurate and usable provider directory. We have recently completed a series of updates to our online directories to make them easier to use for our members and prospective members.

When we learn that information is inaccurate or incomplete, we correct it. The information relating to the four suppliers mentioned in the ministry’s order was corrected in May.

BCBSIL cooperates with the Department and our active engagement with the Department is one of the ways in which we help ensure that we best meet the needs of our members.

Any member with questions about their network or plan benefits should contact us using the number on the back of their member ID card.

John Simley, director of communications for Blue Cross and Blue Shield of Illinois

The president of the Illinois State Medical Society also made a statement to WCIA regarding IDOI’s fine against Blue Cross Blue Shield.

“The Illinois State Medical Society is pleased to see the Illinois Department of Insurance using the authority granted to it under the Network Adequacy and Transparency (NAT) Act supported by ISMS and hold Health Care Service Corporation, the parent company of Blue Cross Blue Shield of Illinois, responsible for yet another violation.

It is remarkable that this company continues to ignore the requirements of the NAT laws to maintain up-to-date, accurate and complete provider directory information for its clients, the patients of Illinois. Inaccurate directory information is frustrating for patients and leads to delays in care. Instead of paying repeated fines now totaling well over $1 million for continued violations of the NAT Act, do the right thing and keep these directories up to date so patients can get the health care they need. deserve.

Rodney S. Alford, MD, MBA, President of the Illinois State Medical Society