State regulators have slapped health insurer Anthem Health Plans of Maine Inc. with a $225,000 civil penalty for its failure to adequately track and respond to customer complaints.

Maine Insurance Superintendent Eric Cioppa said Monday in a news release that Anthem, a subsidiary of New Hampshire-based Anthem Blue Cross and Blue Shield, repeatedly failed to follow up on complaints filed by its customers with the Maine Bureau of Insurance in a timely manner. State law requires that insurers respond to complaints within 14 days, the bureau said, but in nearly two-thirds of all cases Anthem failed to do so.

The bureau’s Market Conduct Unit performed a review of Anthem’s handling of complaints in 2014 after investigators reported several late and missing responses to complaints forwarded to Anthem by the bureau, according to the news release.

“We expect insurers to respond in a timely and substantive manner to issues raised by consumers,” Cioppa said. “Failure to respond to the bureau’s inquiries is a serious issue, as it directly impacts our ability to assist consumers and protect their contractual and legal rights.”

Anthem also did not adequately respond to bureau inquiries about customer complaints, provide requested documents or establish and implement a satisfactory complaint resolution plan, Cioppa said.

The insurer has agreed to pay the $225,000 fine as part of a consent agreement. In addition to the civil penalty, Anthem is required to submit a corrective action plan to the bureau within 30 days of signing the agreement.

Company spokesman Colin Manning blamed the problem on a former employee and acknowledged that Anthem failed to comply with its own policies and state law.

“Anthem Blue Cross and Blue Shield is committed to providing the highest-quality service to our members. Unfortunately, the actions of one individual did not live up to that commitment,” Manning said in a written statement. “We take our obligations very seriously, and the cases identified by the Bureau of Insurance were not handled in accordance with our own internal policies or state law. We took immediate steps to address these issues as soon as they were brought to our attention in 2014, well in advance of the issuance of the bureau report.”

Manning said the employee responsible for the customer complaint failure, along with that employee’s manager, are no longer with the company.

“Additionally, internal policies have been strengthened to help prevent similar actions by individuals in the future,” he said. “Anthem cooperated fully with the bureau during the examination, and we remain committed to providing access to quality, affordable care to all of our members.”

The bureau said its examination of Anthem’s complaint resolution procedures uncovered numerous problems and violations.

Of the 106 customer complaints filed with the bureau during the period examined, Anthem responded within the required 14-day window in only 39 instances, it said.

“Of the 67 complaint inquiries that contained untimely responses, 24 responses were received within 15 days of the statutory deadline, 25 responses were received 15 to 30 days late, seven were received 30 to 45 days late, and 11 were received more than 45 days late,” the bureau said.

The company also did not maintain an accurate written record of customer grievances, according to the bureau. Anthem ultimately admitted that it had failed to register all of the customer complaints it had received.

In addition, the bureau said Anthem did a poor job of responding to its inquiries.

“Throughout the examination, there were numerous instances where Anthem had difficulty providing bureau staff, in a timely and substantive manner, with requested data, information, records, documents and other materials related to the examination,” it said.

Finally, the bureau determined that while Anthem did have a written procedure in place for handling customer complaints, it did not always follow the procedure.

“Anthem’s failure to consistently implement the procedure resulted in Anthem’s inability to maintain an adequate grievance register and ultimately contributed to Anthem’s repeated untimely responses to the complaint inquiries,” the bureau said.

Cioppa said the bureau will be reviewing Anthem’s corrective action plan and will continue to monitor the company’s handling of complaints to ensure that the corrective action has resolved the problem.

Bureau spokesman Doug Dunbar said the regulatory agency has fined insurers in the state as much as $1 million for similar violations in the past, and that the civil penalty against Anthem “is certainly not unprecedented.”

J. Craig Anderson can be contacted at 791-6390 or at:

canderson@pressherald.com

Twitter: jcraiganderson

Copy the Story Link