OLYMPIA,WA—State Insurance Commissioner Deborah Senn put two carriers on notice that they must cease and desist from their practice of refusing to cover services by alternative providers. Ms. Senn charged that the carriers, King County Medical blue Shield and Pierce County Medical Bureau, have been informing subscribers that the law requiring coverage of such services applies only to managed care plans. This is an incorrect interpretation of the law, which took effect Jan. 1, 1996, she said. The carriers are subject to a wide range of discipline, ranging from $10,000 fines per violation to loss of their licenses if they disregard the cease-and-desist order.
The insurance commissioner also issued a formal Declaratory Order that outlines health-insurance carriers’ responsibility under the law. In January, a dozen carriers filed a lawsuit challenging the law, but the court rejected the challenge.
Contact the Washington Insurance Commissioner’s office at 360-586-4422.
New Mexico insurer pays refunds to consumers for overcharges
SANTA FE, NM—Under a settlement reached with New Mexico’s State Corporation Commission, New Mexico Blue Cross and Blue Shield will refund approximately $660,731 to consumers for overpayments of hospital bills. After a year-long investigation, the commission concluded that the insurer failed in many instances "to share with its subscribers the discounts that it negotiated with various hospitals when calculating the percentage of the medical bill to be paid by the subscriber."
While admitting no wrongdoing, the New Mexico insurer has agreed to pay the state a fine of $110,000 and to pay the costs of the Department of Insurance’s investigation, as well as the consumer refunds. Approximately 5,000 subscribers will receive refunds, which will range from $10 to $12,319, with the average under $300. In lieu of
calculating interest on all refund payments, the insurer will make a donation to the
Sante Fe Community Foundation. The refund payments will commence as of Oct. 15.
Contact State Corporation Commission 505-827-4531.
1995’s fastest growing HMOs in Medicaid enrollment
MINNEAPOLIS—Medicaid HMO enrollment increased by 33% in 1995 over 1994 levels, reports InterStudy, which recently released its latest HMO directory. HMOs adding the most Medicaid HMO enrollees are American Health Care Providers (AR) (208,622), HMO BLUE (MA) (118,735), Mid-Atlantic Medical Services (MD) (80,803), Prudential HealthCare HMO (MD) (53,299), and Keystone Health Plan West (PA) (40,075). Contact Interstudy at 800-844-3351 or 612-858-9291.
Washington insurance commissioner puts industry on notice that carriers much comply with alternative providers law
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