Rabu, 15 November 2017

Dept of Managed Health Care Fines Anthem $5 Million

According to Kaiser Health News, the California Department of Managed Health Care (DMHC) has fined Anthem 5 million dollars for failure to address member grievances.  

According to DMHC, between 2013 and 2016, it (DMHC) identified 245 grievance-system violations by Anthem.  

Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.

Read the full article at KHN



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