Blue Cross Blue Shield Illinois reviewed by state – Health Care News

on Jun3

2 June 2017 | 8:07 pm

The Illinois Department of Insurance is investigating how Blue Cross and Blue Shield of Illinois treats customers, for the first time since 1990.

The state’s dominant insurer has gone unreviewed for nearly three decades. Such reviews generally examine how insurance companies pay claims, respond to consumer complaints and advertise, in order to ensure they comply with consumer-protection laws.

The matter was first reported by the Chicago Tribune.

While Blue Cross has avoided scrutiny, its competitors have not, according to the Tribune. State regulators have conducted several broad reviews of UnitedHealthcare of Illinois, Cigna Healthcare of Illinois, Aetna Health of Illinois and Humana Health Plan.

Without a review, it’s impossible to verify that an insurer is operating within regulatory bounds. Examples of problems include failing to confirm to a customer in a timely manner whether a provider is covered, or failing to adequately explain why a claim was denied.

Blue Cross is the largest insurer in Illinois, covering 4.1 million people and employing almost 10,000. It also has made at least $254,000 in campaign contributions to state politicians in 2015 and 2016, according to the Tribune.

If an insurer is found to have problems, it must work with regulators to fix the issue and possibly pay penalties.

A spokeswoman for Blue Cross confirmed the review, but said it “wouldn’t be appropriate to comment on specifics of an on-going exam.” She added that “such exams are a normal part of doing business.”

A spokesman for the Department of Insurance did not respond to questions from Crain’s this afternoon.

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