California health regulators have imposed a $3.5 million fine on Anthem Blue Cross for failing to properly handle thousands of patient complaints about delayed and denied claims over a two-year period.
The California Department of Managed Health Care (DMHC) found that between July 2020 and September 2022, Anthem Blue Cross sent more than 11,000 complaint response letters late, with some delayed by over 51 days. More concerning, over 3,600 required response letters were never sent at all.
Under California law, health insurers must acknowledge receipt of patient complaints within five days. The investigation began after Anthem self-reported consistent delays in their complaint response process.
Anthem Blue Cross has accepted responsibility for the violations and paid the fine. The insurer stated they have implemented new procedures and additional staff training to prevent future delays in handling patient grievances.
The $3.5 million penalty will be directed to the Managed Care Administrative Fines and Penalties Fund, which provides financial support to physicians serving Medi-Cal patients through the Medically Underserved Account for Physicians program.
The DMHC advises health plan members facing issues with denied or delayed care to first file complaints with their insurance provider. If unsatisfied with the response or if the insurer takes longer than 30 days to respond, patients should contact the DMHC Help Center. For urgent healthcare matters, immediate contact with the DMHC Help Center is recommended.
This enforcement action reinforces California's commitment to protecting consumer rights in healthcare and maintaining proper oversight of insurance companies operating in the state.
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