Bismarck, N.D. (Valley News Live) Blue Cross Blue Shield of North Dakota is facing a $125,000 fine for multiple violations found during an investigation by the Insurance Commission.
The examination found deficiencies in how BCBSND processes mental health and substance abuse claims, and that the company’s preauthorization process was not in compliance with the law.
The examination also found that the company was not allowing for independent external reviews for grandfathered plans, failed to provide telehealth services in accordance with the law, violated policy form filing laws, failed to process coordination of benefits claims correctly, and failed to report acts of suspected insurance fraud to the Department as required by law.
In addition to paying the regulatory fine, BCBSND expects to invest more than $300,000 to address issues identified through resources and tools.
"While the nature of these findings are serious, I am confident that with the investments made by Blue Cross Blue Shield of North Dakota and the continued oversight by the Department, we will see continued improvement from our largest health insurance carrier," says ND Insurance Commissioner Jon Godfread. "The result will be better service to North Dakotans without adding to the rising cost of health insurance.”