Maine fines Anthem for delayed response to complaints

Posted Jan. 09, 2017, at 4:16 p.m.

PORTLAND, Maine — Maine’s Bureau of Insurance has fined health insurer Anthem $225,000 because it says the company repeatedly failed to respond to customer complaints within 14 days, as required by state law.

The bureau said the South Portland-based Anthem Health Plans of Maine agreed to pay the fine and within the next 30 days is required to present a plan to prevent future delays, as part of a consent agreement.

The company fired one employee and a manager it said were responsible for the delays.

“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,” Colin Manning, Anthem’s spokesman, wrote in an email. “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.”

The penalties related to customer complaints Maine’s Bureau of Insurance had forwarded to Anthem. After bureau investigators found several late and missing responses to such complaints, it said its Market Conduct Unit began a full review.

The bureau said it found the company “repeatedly failed to comply with Maine law, requiring insurance companies to respond to the bureau’s customer complaint inquiries within 14 days.”

The bureau said investigators also found the company failed to file certain annual data reports and “failed to facilitate a timely completion of the [bureau’s] examination.”

Manning wrote that Anthem “cooperated fully with the bureau during the examination.”

“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,” said Eric Cioppa, Maine’s insurance superintendent.

The Maine attorney general’s office helped with the investigation, the bureau stated.

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