Not an anthem of praise for a major UC provider

The California Department of Managed Health Care announced Wednesday that it had leveled a $5 million fine against Anthem Blue Cross, saying the insurer demonstrated a systemic pattern and practice of failing to identify, process and resolve grievances for enrollees in its managed-care plans.

“The grievance process is fundamental to protecting consumers’ health-care rights and ensuring consumers receive the care they need,” said DMHC Director Shelley Rouillard. “Anthem Blue Cross’ failures to comply with the law surrounding grievance and appeals rights are longstanding, ongoing and unacceptable. The plan must correct the deficiencies in their grievance and appeals system and comply with the law.”

Including this latest enforcement action, DMHC leaders said, the agency has fined Anthem Blue Cross $11.66 million for grievance system violations since 2002. This figure far outstrips the $1.76 million in fines leveled against Blue Shield of California, the insurer with the next highest enforcement actions in this category.

In a statement emailed Wednesday, Anthem spokeswoman Suzanne Meraz said: “Anthem strongly disagrees with the DMHC’s findings and the assertion that these findings are systemic and ongoing. Unfortunately the DMHC has not fulfilled its obligations to clarify the regulatory standards and definitions being applied in the audits, despite multiple requests from Anthem to do so.”...

Full story at http://www.sacbee.com/news/business/article184877248.html