Georgia slaps Blue Cross with historic $5 million fine. Here’s why

Georgia’s insurance department has fined Anthem/Blue Cross Blue Shield $5 million for several violations of state law following a months-long investigation.

“This examination uncovered a number of serious issues, including improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories, and significant delays in loading provider contracts,” state Insurance and Safety Fire Commissioner John King said Tuesday.

“As a result, our office has issued the largest fine in agency history, with potential additional penalties if certain benchmarks are not reached.”

To avoid additional fines, Blue Cross Blue Shield must develop a new process for handling provider complaints, pay claims within the time frames established under state law, and load provider contracts in a timely manner.

In a statement responding to the state’s action, Anthem Blue Cross Blue Shield said the company has worked “diligently” to make changes since the investigation was completed.

“We have since migrated to a new platform with the goal of improving accuracy and transparency,” the statement read. “We are dedicated to those we serve and partner with, and we believe the recent enhancements we have made will create an improved overall care provider experience.”

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.