A national accreditation committee for health insurance plans has denied Trigon Blue Cross and Blue Shield of Virginia its seal of approval.
Accreditation from the National Committee for Quality Assurance is an element businesses look for when picking healthcare plans. Accreditation measures health plans' quality improvement efforts.
Committee spokeswoman Ann Greiner said last week that the committee denied Richmond-based Trigon's request for accreditation for its HMO Virginia and HealthKeepers plans. She declined to say why.
Trigon spokeswoman Brooke Taylor said the problem was with the way Trigon's HMOs monitor themselves.
"It was a matter of not fitting the template," Taylor said.
She said Trigon was changing some procedures and would reapply for accreditation next year.
"We want to participate in this," Taylor said. "We think we have a high-quality product, and we want to organize our quality-improvement program to their satisfaction so we can get the accreditation."
In granting accreditation, the committee looks at how well a health plan meets 50 standards, including whether a plan fully examines the quality of care given members, the steps it takes to be sure enrollees have access to care in a reasonable amount of time, and how responsive a plan is to complaints and appeals involving denied claims.
About 13% of the health plans that have applied for the committee's accreditation have failed to get it. Some 34% have won full accreditation, while 37% have won a one-year accreditation for meeting most of the standards. Fourteen percent have won a provisional accreditation for meeting some of the standards. The remaining 2% are under review.
In Virginia, Prudential Health Care System has full accreditation, while Cigna HealthCare of Virginia and Southern Health Services have one-year accreditations.