Under the settlement, announced by the California Department of Managed Health Care, Anthem will pay $2.8 million to the state and invest $8.4 million into improving how it logs customer calls. The settlement closes an appeal of a $5 million fine the department issued against the insurer in 2017 after accusing Anthem of systemically failing to answer customer grievances within a required 30-day window.
DMHC Director Shelley Rouillard told The Sacramento Bee the $2.8 million penalty “is a very large fine for us, and it’s appropriate in this case because, for many years, Anthem has improperly denied consumers their right to information about how they can appeal decisions that Anthem has made and how Anthem has handled what we call grievances.”
In a statement to The Sacramento Bee, Anthem Blue Cross spokesperson Michael Bowman said the insurer is satisfied with the resolution: “Anthem is making significant changes in our grievance and appeals process, as well as investments in system improvements to help ensure we are simplifying the healthcare experience for consumers.”
More articles on payers:
Anthem to cover some WellStar services, state order says
Q&A: Allina Health | Aetna CEO on the joint venture’s first year
UPMC backpedals on controversial prepayment policy
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.