Information about Market Conduct Examination
Recent media reports may be misleading, please refer to this article for accurate information regarding Blue Cross and Blue Shield of Oklahoma’s Market Conduct Exam.
The Oklahoma Insurance Department (OID) recently concluded a Market Conduct Examination of Blue Cross and Blue Shield of Oklahoma (BCBSOK) covering the period of January 2013 through December 2015. The OID's exam period includes the time when BCBSOK was implementing the Affordable Care Act's most sweeping reform — the Health Insurance Marketplace. The exam looked at claims handling and service issues that primarily affected members who purchased individual coverage, which is about 20 percent of our members. Members who have received health coverage through their employers or Medicare were not impacted.
The Insurance Commissioner has assessed a deferred fine against BCBSOK and will allow us 12 months to remediate issues identified by the OID. Following the successful completion of the plan to the Commissioner's satisfaction, the fine will be withdrawn.
Since the roll out of the Affordable Care Act, we have learned valuable lessons to improve our operations. We are now on the path to provide better service than ever before. Some of the solutions we have implemented include:
- Increased number of call center staff to handle increased volume of customer inquiries, including a 24/7 customer service hotline.
- Implemented more streamlined and time-efficient enrollment processes for our members, as well as new cancellation and termination processes. These efforts have increased transparency and efficiency related to enrollment.
- Established real-time payment processing, on demand invoicing and increased payment options to increase convenience and help members save time.
- Improved our member ID cards to include more detailed information about BCBSOK's services and policies as well as the individualized plan.
- Added new tools and service capabilities to enhance members and providers' experience and improve how we respond to customer feedback.
- Rolled out our Mobile Assistance Center (MAC), a mobile unit and team dedicated to providing one-on-one customer service, education, bilingual services, information and community outreach to metro, rural and tribal areas.
BCBSOK is committed to the communities that we serve. Considering our health care coverage options are in all 77 counties of the state of Oklahoma, we are very much committed to all Oklahomans. With outreach initiatives like the MAC, we have a strong presence throughout the state.
For 2017, BCBSOK will continue the great strides we have made in our communities and will implement a statewide community outreach plan focused on equipping consumers with information needed to navigate the health care system and take action to maintain and improve their health. To help with these efforts, we are expanding the MAC team to include two mobile units — one located in Tulsa and one in Oklahoma City — to focus on customer service and health insurance education.
In addition to expanding our MAC team, our plan includes the following:
- Continued expansion of the Oklahoma Caring Vans' outreach to underserved children through new partnerships and expanded capabilities
- Proactive media and social media campaigns in English and Spanish to promote health literacy to make it easier for consumers to access and understand health information
- Increase on-site visits to primary care and specialty physician offices
- Member support through outreach to Producers/Agents/Group Leaders
Members who may have questions, can call the phone number on the back of their ID card.