State fines Blue Cross $3.6M for customer service problems

Posted September 15

— The state Department of Insurance on Thursday fined Blue Cross Blue Shield of North Carolina $3.6 million for hundreds of customer complaints over enrollment and billing early this year.

The fine is the largest the DOI has ever levied and almost double the previous record against a single company.

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 irate callers, and many customers were left frustrated and even angrier because they couldn't speak to anyone to get their problems addressed.

Insurance Commissioner Wayne Goodwin in February launched an examination of Blue Cross' compliance with state laws and regulations, and after months of haggling, they agreed on the $3.6 million fine to settle their differences.

"Blue Cross Blue Shield had to be held accountable," Goodwin said in a statement.

The settlement calls for the fine to be paid out of Blue Cross' surplus and not be passed on to consumers or used to justify any rate increases. The money will be disbursed to public schools.

Blue Cross acknowledged in the settlement that it had problems and didn't respond in a timely manner, but it blamed the issue on "technology failures" that have since been fixed. The company said it already has paid $11.3 million in restitution to policyholders and another $8.3 million on claims made by health care providers.

"We have been actively addressing these issues and expect to be stronger as a result of this process," Blue Cross said in a statement. "We remain committed to our customers and the communities of North Carolina and are deeply sorry for the challenges that this created for our customers and providers."


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  • Dean Morron Sep 15, 6:27 p.m.
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    And the BIG winner in all of this .... the State of North Carolina, not the disgruntled customers whose accounts were poorly handled. Why not give the fines back to the consumer ?

  • Mark Cooper Sep 15, 4:32 p.m.
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    I am not sure I agree with this. I think actions needs to be taken for certain but the 3.6m will be passed right back to the consumer and right now health care for those not eligible for a healthcare subsidy are getting eaten alive in premiums which are forecast to go up dbl digit %'s.