Centene fined $1.5m by Washington insurance regulator


Centene fined $1.5m by Washington insurance regulator

iStock/ Jamesbenet

Healthcare firm Centene's Washington subsidiary, Coordinated Care, has reached an agreement with the State of Washington Office of the Commissioner (OIC), to resume selling health insurance plans in Washington state.

Insurance Commissioner Mike Kreidler had issued a "cease and desist" order on December 12, ordering the company to stop selling individual health plans in Washington state because it failed to maintain an adequate network of medical providers.

The company has been fined $1.5 million with $1 million suspended, pending no further violations over the next two years.

The Washington state's insurance regulator issued the following statement: "Coordinated Care admitted to not having enough anesthesiologists in King, Snohomish, Pierce and Spokane counties. According to the company’s own data, its provider network is also seriously deficient in other categories of providers, including immunology, dermatology, and rheumatology."

Kreidler’s office received more than 140 complaints from Coordinated Care enrollees this year who have had difficulty with their coverage. This included accessing in-network providers and receiving surprise medical bills.

"Coordinated Care Corp. has agreed to a consent order detailing steps it must take to fix its provider network deficiencies and other ongoing issues. With the consent order in place, the order instructing the company to stop all sales is canceled," it stated.

Kreidler said: "I’m pleased that we have reached agreement with Coordinated Care to correct its inadequacies. They understand the seriousness of the violations and made a commitment today to correct them. We will be monitoring the company very closely to make sure that policyholders are protected and they receive the coverage they’ve paid for."

Centene said in a statement: "We are pleased to work collaboratively with the OIC to continue to offer affordable healthcare coverage to the State of Washington consumers through the Ambetter marketplace program.

"We will continue to work closely with the OIC, including continuing to make refinements and improvements to our network reporting processes. We are committed to address known issues in our network in select regions of the state, and we have taken actions to ensure our members have access to these services. Ambetter from Coordinated Care continues to grow its network and add providers.

“Many of the counties Ambetter serves are rural counties, which may not have all specialists located within those counties; however, our members can access these specialists located elsewhere within our network footprint. We have over 15,000 providers in-network, statewide, representing all specialties, including 40 hospitals."

Consumers who bought Coordinated Care plans through Washington state’s Exchange after Dec. 12 will have those policies in effect for 2018.

Centene, Washington, Coordinated Care, Health insurance, Mike Kreidler, US