Godfread Announces Examination of Blue Cross Blue Shield Behavioral Health and Substance Abuse Coverage Practices

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Categories: Companies Health Insurance

BISMARCK, N.D. – Insurance Commissioner Jon Godfread today announced a market conduct examination of Noridian Mutual Insurance Company, which sells health insurance in North Dakota as Blue Cross Blue Shield of North Dakota (BCBSND).

“In the face of the opioid and addiction crisis, it’s extremely important to make sure North Dakotans with health insurance are receiving the benefits promised to them by their health insurance company,” Godfread said. “That’s why one of the main focuses of this exam will be to ensure that addiction and behavioral health services are being covered appropriately.”

A market conduct examination is an investigation conducted by the North Dakota Insurance Department to determine whether an insurance company is following laws regulating the insurance business and whether the company is providing benefits in accordance with the policies it has issued to North Dakota consumers. Under North Dakota law, the Department has the authority to examine any insurance company doing business in North Dakota. This examination will cover BCBSND’s operations as of June 1, 2013 through Feb. 28, 2018. The targeted areas of examination include:

  • Mental and behavioral health and substance abuse claims, including parity;
  • Telehealth services coverages and claims;
  • Independent external review assignment and procedures;
  • Policy form filing;
  • Coordination of benefits;
  • Insurance fraud reporting; and
  • Corporate governance and governance of subsidiaries.

During the examination, which began March 12, the materials and findings are confidential until a final exam report has been issued. It is anticipated that this exam will take six to eight months to complete. Until such time as a final report is issued, the Department will not be able to comment on any potential findings.

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