A Battle Won: $3.6 Million Record-Setting Fine Against Blue Cross Blue Shield

By Erica Dickson


We at Denials Management, Inc. (DMI) are perpetually at war against the leviathan that defines insurance companies. But we are not in it alone.

Our allies work tirelessly to hold accountable these seemingly untouchable companies within their own state lines. Although insurance companies have been held over the coals in the past, more and more investigations are being launched into nefarious practices, reigning in the fast and loose way the game has been played.

On September 15, 2016, North Carolina Insurance Commissioner, Wayne Goodwin, slapped a record-setting $3.6 million fined against Blue Cross Blue Shield of North Carolina (BCBSNXC). This unprecedented fine against the insurance behemoth, was brought on by the thousands of complaints that started to spill in from BCBSNC customers in January 2016.

In this short period of time, the amount of allegations regarding the treatment customers received from BCBSNC’s customer service department not being available by telephone or via their website, coupled with issues of not receiving their valid identification cards, incorrect cancellation notices, and major difficulties with billing and coverage, demanded attention.

Many of these BCBSNC customers are clients of DMI, due to BCBSNC’s chronic, egregious errors in over-billing, double-billing, failing to confirm coverage, refusing to pay for coverage when coverage exists under exploitative and iniquitous reasoning, cancellation of coverage customers opted for and signing others up for policies they never wanted.

All in all, over 3,500 customers lodged formal complaints against BCBSNC with Commissioner Goodwin’s office from January through the end of August.

When these complaints began to surge into the North Carolina Insurance Department, it was only a matter of days before doctors and other providers weighed in with their issues. Notably, many providers stated that reimbursements through BCBSNC were being deliberately delayed for weeks, and in some cases, months.

This financial reprimand handed down to BCBSNC from the Insurance Department of North Carolina, is not only record-breaking in its financial amount, but historical for our industry.

On March 1, Susan L. Donegan, Commissioner of the Department of Financial Regulation of Vermont, issued fines totaling over $150K. In September, Washington State Insurance Commissioner, Mike Kreidler, issued fines against those insurance companies and brokers that had violated multiple regulations.

More than ever before, insurance companies are being watched. The good fight is catching fire, and yes, a battle has been won, but the war against corrupt insurance is far from over.

DMI and our allies continue to give the thousands of clients we have—and the thousands more out there—a voice to be heard, and the knowledge that Goliath isn’t unconquerable.

Together, we are all becoming a force to be reckoned with.