Health insurer Centene Corp. has landed in hot water after its Washington subsidiary Coordinated Care Corp. was fined $1.5 million and briefly banned from selling individual insurance plans in the state because its coverage network didn't have enough doctors.
Centene can now resume selling plans after agreeing to fix its provider network adequacy issues, Washington's insurance commissioner said Friday.
Insurance Commissioner Mike Kreidler on Tuesday sent Centene a cease-and-desist order to stop selling individual plans. The order came after more than 140 consumers complained to the commissioner's office about having trouble finding in-network providers and the surprise medical bills they've received because of the inadequate network.
The commissioner's office said Centene's network lacked several types of providers, including those in immunology, dermatology and rheumatology. Centene also admitted to not having enough anesthesiologists in four counties, the commissioner's office said. The office has been working with Centene since mid-May to address its network deficiencies.
Of the $1.5 million fine levied against Centene, the commissioner's office said it will suspend $1 million as long as there are no further violations in the next two years.
"I'm pleased that we have reached agreement with Coordinated Care to correct its inadequacies," Kreidler said in the announcement. "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."
Centene did not immediately return a request for comment.
Centene is the only health insurer selling plans on the Affordable Care Act exchanges in three Washington counties. It insured 38,000 people on the state's exchange as of September.
While other insurers have struggled to turn a profit on the ACA exchanges, St. Louis-based Centene has thrived largely because of its narrow-network, low-premium plans that attract price-sensitive customers.
The insurer uses narrow networks to steer consumers to certain doctors and hospitals, often excluding the highest-cost systems. Consumers who receive care outside of the narrow network are often sacked with a higher bill.
Coordinated Care's membership totaled 238,000 at the end of 2016.
