Anthem repays $9.2 million to thousands of Californians billed in error. Who was affected?
The California Department of Managed Health Care levied $1.1 million in fines against Anthem Blue Cross over two legal violations, one of which increased out-of-pocket costs for consumers over a four-year period, the agency announced Thursday
“These violations had financial impacts to enrollees and deprived enrollees of information on their rights to file a complaint or apply for an Independent Medical Review with the DMHC Help Center,” said Mary Watanabe, the director of the department.
Anthem incorrectly required consumers to pay office visit costs as part of their deductibles, a billing error that resulted in 6,561 enrollees paying out $9.2 million to their providers from 2015-2020, the agency said. Certain office visit costs should have been included, DMHC officials said.
In 2019, Anthem failed to mail out the explanation of benefit notices to 363,257 plan enrollees. All insurers must send out these documents — they explain a number of things, including how consumers can make appeals or complaints.
Colin Manning, a spokesman for the insurer, said that “Anthem Blue Cross strives to provide access to outcomes-based health care in accordance with applicable state laws and regulations. We worked with the Department of Managed Health Care in resolving these matters ... that have since been corrected. We are dedicated to those we serve and apologize for any inconvenience this may have caused.”
Watanabe said: “Anthem Blue Cross has agreed to take corrective actions including reimbursing impacted enrollees and updating the plan’s policies to make sure these issues do not happen again.”
The company reported the errors to the agency and has taken corrective action to ensure such violations do not happen again. It also agreed to identify and make restitution to consumers who were incorrectly forced to make out-of-pocket payments. Manning noted that all members who were owed the funds already have been reimbursed, with interest if appropriate.
“The DMHC’s enforcement actions against Anthem Blue Cross are a strong reminder that the department will hold health plans accountable to the law and protect consumer’s health care rights,” Watanabe said.
If health plan enrollees are having trouble getting the care they need, the Department of Managed Health Care encourages them to file a grievance or an appeal with their health plan, officials said. If they do not agree with their health plan’s response or the plan takes more than 30 days to resolve non-urgent issues, consumers can seek help from the DMHC Help Center at healthhelp.ca.gov or 888-466-2219.
If enrollees have urgent issues, they can reach out to the DMHC Help Center 24 hours a day, seven days a week.
This story was originally published June 9, 2022 at 12:09 PM with the headline "Anthem repays $9.2 million to thousands of Californians billed in error. Who was affected?."
