Blue Cross fined $3.6M by NC for billing, enrollment problems

Raleigh -- The N.C. Department of Insurance has levied a record $3.6 million fine against Blue Cross and Blue Shield of North Carolina for chronic malfunctions that have led to billing and enrollment errors for Blue Cross customers since January.

The Insurance Department and Blue Cross, the state’s largest health insurer, agreed to the fine amount Thursday, ending a six-month agency investigation in what has been the most challenging year in the insurance company’s history. The agency cited a spate of problems, including over-billing, double-billing, failing to confirm coverage, canceling coverage customers wanted, and signing customers up for policies they didn’t want.

Nearly 3,500 customers and medical providers lodged complaints with the agency through the end of August. Doctors and other providers said Blue Cross delayed insurance reimbursements by weeks and even months. The Insurance Department intervened on behalf of patients in immediate need of medical attention, and small medical practices that faced a cashflow crisis when Blue Cross stopped making payments.

“As your insurance commissioner and an advocate for consumers across North Carolina, Blue Cross and Blue Shield had to be held accountable,” Insurance Commissioner Wayne Goodwin said in a statement.

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