Thursday, August 29, 2024
DMHC Fines Blue Shield of California $250,000 for Illegally Billing Members for Contraceptive Health Care Services
(Sacramento) – The California Department of Managed Health Care (DMHC) took enforcement action against California Physicians' Service (Blue Shield of California), including a $250,000 fine, for illegally billing health plan members for contraceptive health care services. The plan paid the fine, and made $228,254 in reimbursements, interest and penalty payments to 334 members who were incorrectly charged.
“Under the law, health plans must cover contraceptive health care services for all members without imposing a deductible, coinsurance, copayment or any other cost-sharing requirement,” said DMHC Director Mary Watanabe. “The plan violated the law when it charged members for covered contraceptive health care services.”
BACKGROUND: California law requires health plans to cover contraceptive drugs, devices, and products approved by the federal Food and Drug Administration at no cost to the health plan member. This includes follow-up services related to the drugs, devices, products, and procedures, including but not limited to management of side effects, counseling for continued adherence, and device removal. In this case, a health plan member was billed cost-sharing by Blue Shield of California for the removal of a hysteroscopic intrauterine device (IUD), which should have been covered at no cost under the law. The member filed a grievance with the plan, but the plan upheld its decision to bill the member. The member then filed a complaint with the DMHC Help Center which led to a broader investigation by the DMHC.
IMPACTED HEALTH PLAN MEMBERS: During the DMHC’s investigation, Blue Shield of California conducted an audit and identified 334 other health plan members who were wrongfully charged a cost share related to covered contraceptive health care services between 2016 and 2019. The plan reimbursed the impacted members, including interest.
WHAT HEALTH PLAN MEMBERS CAN DO: The DMHC encourages health plan members experiencing issues with their health plan, including billing issues or denials of health care services, to file a complaint, also called an appeal or grievance, with their health plan. If the member does not agree with their health plan's response or the plan takes more than 30 days to fix the problem for non-urgent issues, the DMHC Help Center can work with the member and health plan to resolve the issue. If a health plan member is experiencing an urgent issue, they should contact the DMHC Help Center immediately.
Health plan members can file a complaint or apply for an Independent Medical Review with the DMHC Help Center at www.DMHC.ca.gov or 1-888-466-2219.
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About DMHC:
The DMHC protects the health care rights of more than 29.8 million Californians and ensures a stable health care delivery system. The DMHC Help Center has assisted approximately 2.9 million Californians to resolve complaints and issues with their health plan. The DMHC Help Center provides assistance in all languages and all services are free. For more information visit www.DMHC.ca.gov or call 1-888-466-2219.