Blue Cross CEO: Still weeks away from solving enrollment problems

Posted March 16, 2016

— Blue Cross Blue Shield of North Carolina continues working to resolve customer problems that started more than two months ago, and Chief Executive Brad Wilson said Wednesday that the company is still weeks away from finishing.

The state's largest health insurer opened the year with about 25,000 customers who were either enrolled in plans they never signed up for or had the wrong amount of money drafted from their bank accounts. Others waited weeks for identification cards to prove to providers that they had health coverage.

The company's customer service center was swamped by thousands of irate calls, leaving many people frustrated and even angrier because they couldn't speak to anyone to get their problems addressed.

"It was an avalanche that overran us," Wilson said in an interview with WRAL News. "Once you get behind, it takes a while to dig out."

The volume of calls to the customer service center has ebbed back to normal levels, Wilson said, blaming the problems on enrollment software that failed amid a crush of people signing up for coverage in late December.

"It set off a cascade of events that ran through the system," he said, noting that enrollment data was then tied to benefits, premiums and claims. "We’ve got plenty of work left to do, but we’re going to stay at this until every customer’s concerns, problems, challenges have been met."

The subsequent flood of complaints to the state Department of Insurance prompted Insurance Commissioner Wayne Goodwin to order a performance audit of Blue Cross to determine whether any state regulations were violated. Wilson said the process started Monday.

"I cannot speculate whether or not we deserve a fine or whether they will ultimately levy one," Wilson said. "What I do know is that we are going to fully cooperate with them, (and) we’re going to learn as much as we can from the process."

Blue Cross also is studying its future under the Affordable Care Act after losing $282 million on plans purchased through the marketplace last year. That was more than double the $123 million the company lost on such plans in 2014.

"It's time we take stock as prudent businesspeople and understand what it means for our company," Wilson said.

No decisions will be made until later this year – after the Department of Insurance has weighed in on any rate increases Blue Cross proposes – and Wilson said "everything is on the table," from dropping ACA coverage in some or all North Carolina counties to cutting back on the menu of plans the company offers.

"We're going to work hard to make it work for North Carolina," he said, calling providing ACA coverage "part of our mission."

Blue Cross is the only insurer to offer marketplace plans in many North Carolina counties, so any scaling back could leave some state residents without coverage options.

"That would be a very unfortunate outcome," he said.

Wilson said the health care law needs to be changed to make it more stable for insurers. He called for fewer enrollment periods and for stiffer penalties for people who don't sign up for coverage.

"Not enough healthy people are signing up for the ACA," he said. "The evidence is building that (the tax penalty) is not strong enough to attract a large enough pool, a diverse enough pool, to sustain the ACA."


Please with your account to comment on this story. You also will need a Facebook account to comment.

Oldest First
View all
  • Sick Ofhollywood Mar 17, 2016
    user avatar

    How's that outsourcing IT work'n for you? Worked there several years ago, and then walked out. Company should be taken over by the Court, and re-vamped completely. Never seen a more incompetently managed business in my life.

  • Erik Nystrom Mar 17, 2016
    user avatar

    View quoted thread

    All the people who work in their customer "service" call center work at their building in Durham on Ivy Creek Blvd and in Madison Park in Winston-Salem. All of the employees who work there in the call centers are grossly underpaid and have very high turnover.

  • Ryan Walsh Mar 16, 2016
    user avatar

    You have to deal with the market place not BCBS in most cases. Its not all their fault like WRAL and everyone thinks, the market place and the insurance have to communicate and update each other faster. I had a cluster F with United HC and finally resolved everything by letting the Marketplace handle it and resolve the case. I think this whole model will ultimately crumble like Obama wanted it to.

  • Ronan Cates Mar 16, 2016
    user avatar

    This company and the executive are costing me 1800 a month and then they top it off by mismanagement. He should be fired on the spot.

  • Jackson Smith Mar 16, 2016
    user avatar

    I have almost 20 hours on hold trying to reach BCBS NC this year and yet the CEO can get a 34% raise. This is crazy and I will be getting my insurance from Untied Health Care or someone else in the future. The entire UNC system has dropped BCBS for healthcare. How can they not be required to pay tax as a not for profit when they are just screwing the citizens of this state.

  • Andy Jackson Mar 16, 2016
    user avatar

    View quoted thread

    I agree that some call takers "may" be a third party call center, but all are not (I know that for certain). Also, while they claim to be a non-profit, read this article. Have a good day.

  • Tracy T. Dalrymple Mar 16, 2016
    user avatar

    I had to laugh when Mr. Wilson was saying BSBSNC has lost money due to the ACA. The loss would be significantly less if he and his executives weren't compensated so exorbitantly. He alone, received a 34% salary increase, total compensation package of $3.8 million.

  • H Lee Dawson Mar 16, 2016
    user avatar

    BCBS can't make a profit, like the NFL, it is a non-profit orgaization. Don't get upset with the people on the phone, they are probably a third-party call-center hard to take the call. They get paid poorly and have an ridiculous standards to me.

  • Andy Jackson Mar 16, 2016
    user avatar

    1 final note: their blaming the ACA for their losses is a bunch of junk. And, while they made a profit (yippee).... anyone who thinks that BCBS will not pass along the losses to consumers via rate increases is asleep at the wheel. There are lots of other health insurance companies, who have great customer service, who would love to get your business. Just a thought........

  • Andy Jackson Mar 16, 2016
    user avatar

    They are not only having problems with Enrollment, but also claims processing questions from providers, consumers, and general questions from consumers. When you hold on for almost an hour, unless you tell the customer Rep. something like "I owe BCBS money, AND I have a claims question".....they insist on calling you back, and if you get to speak with a person, some are down right RUDE! The CEO needs to fix these long standing issues, or be fired. They used to be a superior company to do business with, but no longer. They "think" we won't shop around and move our insurance to another carrier. Their arrogance is catching up with them. Such a shame.....but their doing.