OIC allows Coordinated Care to resume sales of individual plans under network adequacy consent agreement

December 20, 2017

On December 12, the Washington Office of the Insurance Commissioner (OIC) ordered Coordinated Care Corporation to stop all new sales of individual health plans due to concerns regarding network adequacy. On December 15, OIC agreed to allow Coordinated Care to resume sales under a consent agreement where Coordinated Care agreed to fix it network deficiencies. The order also required Coordinated Care to pay a fine of $1.5 million, $1 million of which will be suspended if it is successful in meeting requirements over the next two years. The OIC action does not affect Apple Health enrollees covered through Coordinated Care, as provider networks of Medicaid managed care plans are reviewed through the Health Care Authority.

In its communication, OIC indicated the action was due to numerous unresolved enrollee complaints regarding the company’s lack of an adequate provider network, related surprise billings, and the company’s prior failure to correct its deficiencies. (Andrew Busz, andrewb@wsha.org)


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