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Blue Shield of California, Anthem Blue Cross fined for inaccurate provider directories

Companies may pay out millions to reimburse consumers for out-of-network costs

Two health insurance companies, Blue Shield of California and Anthem Blue Cross, have been fined by California insurance regulators for misleading consumers about their physician networks on the state's insurance exchange, according to the Los Angeles Times.

While the fines may be minimal for these insurance giants, the companies will pay out millions of dollars in refunds to patients who incurred bills for out-of-network care, regulators told the newspaper.

California's Department of Managed Health Care fined Blue Shield of California $350,000 and Anthem Blue Cross $250,000 for overstating their doctor networks, the Times reported. The inaccuracies by the insurers in their provider directories caused major frustration and unexpected out-of-network medical bills for consumers across the state during the rollout of the Affordable Care Act in 2014 as they searched for providers on the Covered California exchange.

Insurance regulators said both companies must improve their provider directories and reimburse enrollees, according to the article. Blue Shield has already reimbursed patients more than $38 million. A figure was not available yet from Anthem, but the company told the newspaper it is close to settling a class-action suit that would set aside money to cover consumer medical bills. Both companies have acknowledged they made mistakes during the insurance exchange rollout and said they have acted to correct information.

It's not the first time the two insurers have come under the microscope. Anthem Blue Cross recently agreed to reimburse about 50,000 California customers nearly $8.3 million to settle a class-action suit charging it had raised the costs of policies mid-year. Blue Shield of California had its tax-exempt status revoked by the state in March and its CEO pledged to improve service to members and disclose more about its executives' compensation after coming under scrutiny from consumer advocates and the state.

To learn more:
- read the article

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