California fines Anthem Blue Cross for violating customers' grievance rights

A.J. Mast/Getty Images

Listen to story

Download this story 0.0MB

The Department of Managed Health Care said Tuesday that it has fined Anthem Blue Cross $415,000 for violating some of its health plan members' grievance and appeal rights.

The penalty levied against Anthem Blue Cross involved 83 violations in 40 cases.  They include failure to adequately consider and resolve an enrollee’s grievance; failure to resolve a grievance within the 30-day time frame set forth under state law; failure to adequately explain the reason for denying treatment; and failure to respond in a timely fashion to Managed Health Care's investigation. 

An Anthem spokesman says the company has already taken steps to resolve the problem.

"Anthem has provided additional training to its staff and implemented a new tracking system to reduce delays with the grievance and appeals system," says company spokesman Darrel Ng.

California law gives health plan customers the right to know why a plan denies them service or treatment. Customers also have the right to file a grievance if they disagree with the insurer’s decision and to request an independent medical review from Managed Health Care.

Here are five tips on how to pursue a complaint against your health insurance company.