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Life Health > Health Insurance

Nebraska Fines Bright Health $1M

By Allison Bell

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The Nebraska Department of Insurance made a point of fining Bright Health and criticizing its response to a state regulatory exam, even though the company is already getting out of the health insurance business.

The department recently published a consent order showing that the Minneapolis-based company has agreed to pay a $1 million penalty in response to concerns about how it handles health insurance claims.

Bright Health is also supposed to send the department a monthly claim payment status report, and the department posted a report emphasizing that examiners’ assessment of the company’s claim handling problems may be incomplete, “due, in part, to the company being uncooperative and dismissive of regulators’ questions in certain instances.”

The company: Bright Health is one of several small, for-profit companies that tried to jump into the market for Medicare Advantage plans and Affordable Care Act individual major medical insurance plans just as COVID-19 was about to send claims soaring, disrupt operations and roil the capital markets.

The company increased enrollment rapidly and had trouble raising capital to support its business. It announced in May that it would be getting out of health insurance and focusing on running health care clinics.

The exam: Nebrask officials say they reviewed files related to 91 consumer complaints along with a random sample of other records.

The exam uncovered many problems, such as the company requiring insureds to pay cost-sharing amounts for 2,245 immunizations, even though federal law required the company to cover the immunizations with no cost sharing.

The company also violated rules by denying coverage for 163 newborn dependents that the company should have covered, examiners found.

“The company failed to provide claim delay letters and stated they did not historically send such delay letters, even though required by law to do so,” examiners added.

The settlement: Although Bright Health is winding down its operations, the company “continues to process claims in the normal course of their business,” a department representative said in an email.

The consent agreement requires the company to cooperate with the department’s claim-paying compliance requirements, the representative said.

Credit: Adobe Stock

Allison Bell

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