Coordinated Care Corp. has agreed to a consent order detailing steps it must take to fix its provider network deficiencies and other ongoing issues. The company was fined $1.5 million with $1 million suspended, pending no further violations over the next two years.
Insurance Commissioner Mike Kreidler issued a cease and desist order Dec. 12 ordering the company to stop selling individual health plans in Washington state because it failed to maintain an adequate network of medical providers.
In particular, 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.
With the consent order in place, the order instructing the company to stop all sales is canceled.
Anyone who bought Coordinated Care plans through Washington state’s Exchange after Dec. 12 will have those policies in effect for 2018.
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.
All health insurers are required to monitor their provider networks and identify problems and report them to the insurance commissioner’s office, including how consumers can access those services.
In investigating the consumer complaints, Kreidler’s office has worked with Coordinated Care since mid-May and instructed the company to correct its network and ensure that people are not wrongly charged for covered services.
“I’m pleased that we have reached agreement with Coordinated Care to correct its inadequacies,” said Kreidler. “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.”
Anyone with coverage from Coordinated Care who has received a surprise medical bill from the company should contact the insurance commissioner's office.
Coordinated Care has the third-largest market share in Washington’s Exchange, with 38,000 people enrolled as of September 2017.
