Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, April 14, 1995 TAG: 9504140031
SECTION: BUSINESS PAGE: A-11 EDITION: METRO
SOURCE: Associated Press
DATELINE: RICHMOND LENGTH: Medium
Trigon Blue Cross Blue Shield admitted no wrongdoing in accepting the settlement.
The deal marks the second time in less than a year that Trigon has agreed to a hefty settlement to end a state investigation. The company agreed to a $5 million settlement, the largest ever accepted by the SCC, to end a probe of allegedly illegal billing practices last September.
SCC spokesman Ken Schrad said the most recent settlement stems from a routine evaluation of Trigon's advertising and promotional materials. The insurance bureau conducts such reviews every two to three years, he said.
``In this instance, they found enough problems that they considered it not just oversights, but routine business practices that in the bureau's opinion are in violation of Virginia insurance laws,'' Schrad said.
He said the alleged violations were in promotional materials aimed at potential buyers of group health insurance policies.
For example, one pamphlet mentioned discounts on dental and eye care benefits that were not included in the policy being advertised. Others failed to disclose that the company does not serve certain Northern Virginia localities.
The SCC said $538,000 of the settlement will be paid to the state as a civil forfeiture.
The remaining $412,000 is an estimate of interest owed to health care providers on claims that were not paid within state-set deadlines.
Officials of Trigon, which insures about 1.8 million Virginians, did not immediately return a phone message seeking comment.
But in a written release Trigon said that the report had also identified areas where Trigon has shown significant improvement since the last survey in 1985-87. These included dealings with agents and brokers and handling of customer complains and inquiries.
The company said that the report also found that Trigon met industry and regulatory standards in the areas of underwriting and rating processes and practices, privacy act compliance, and billing practices.
Staff writer Mag Poff contributed to this story.
by CNB