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BCBS of North Carolina could face hefty fines for administrative issues

Insurance commissioner Wayne Goodwin says insurer's tech problems should be resolved by now

Blue Cross Blue Shield of North Carolina (BCBSNC), which continues to grapple with technology issues that have wrecked havoc on its enrollment and billing systems, may be facing $1,000 or more in fines a day per violation, according to an article from the News & Observer.

The state's department of insurance is especially concerned with the fact that 70 BCBS priority cases had to be reopened recently because enrollment and billing problems resumed. Insurance Commissioner Wayne Goodwin tells the newspaper that he is seeking any evidence that could be used to calculate a fine against the insurer. Goodwin, who is up for re-election in November, claims BCBSNC is making slow progress in its effort to fix a technology fiasco that should have long been resolved by now.

"Blue Cross has the resources to hire as many people as they need to rectify this matter," Goodwin said.

The insurer started to hear complaints in January, after it tried to transfer almost half a million customers from a legacy software system to a new billing and enrollment platform. BCBS announced in February that it was going to delay the transfer of 600,000 more customers due to the issues that came up in December. The problems included wrongly charging coinsurance, errors in calculating deductibles and denial of service--though BCBSNC reports that the issues have been largely solved, according to the article.

Goodwin added that billing overcharges impose a financial burden on people, and for customers who have not been able to confirm coverage, BCBSNC suggests they pay for services out-of-pocket and seek reimbursement later, according to the News & Observer.

Despite the fact that BCBSNC has reimbursed more than $2 million to its customers following the software flub, Goodwin tells says that's not enough. He wants a change in the state law that would allow him to order the insurer to pay restitution to customers.

To learn more:
- here is the News & Observer article

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