IL – Blue Cross Blue Shield Awaits State Review

June 2017 ~

For the first time since 1990, the Illinois Department of Insurance will conduct a broad market examination of Blue Cross and Blue Shield of Illinois (BCBSIL) to see how the insurer treats its customers in compliance with consumer protection regulations.

While the Illinois Department of Insurance is not required to conduct regular reviews, the Department has conducted at least three broad reviews of UnitedHealthcare of IL, at least four of Cigna Healthcare of IL, at least two of Aetna Health of IL and at least four of Humana and released a narrow review of HCSC in 2011. BCBSI is an outlier, when compared to its competitors, with the last publicly released review taking place 27 years ago.

Experts say it is not uncommon for such time gaps between state reviews to occur. Some states perform reviews regularly while others perform them as needed, such as after a pattern of complaints, according to Georgetown University’s Center on Health Insurance Reforms research professor, Sabrina Corlette.

A spokeswoman for BCBSIL confirmed the Department’s review of its consumer treatment in areas such as advertising, enrollment, claim payments and complaints, stating the insurer is “more than happy to cooperate” with state regulators on the reviews “to make sure we’re serving our members the best possible way,” but said it “wouldn’t be appropriate to comment on specifics of an on-going exam.” She added that “such exams are a normal part of doing business.”

Department regulators will weigh factors such as how long it’s been since the last exam, complaints and other states’ regulatory actions, but there are no specific triggers in state law for conducting an exam. If an insurer is found to have problems, it must work with regulators to fix the issue and possibly pay penalties.

Illinois Department of Insurance spokesman, Michael Batkins, said the Department expects to finish its examination within the next three to six months.

Source(s): Modern Healthcare; Becker’s Hospital Review; Crain’s Chicago Business;