Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, July 26, 1995 TAG: 9507260060
SECTION: BUSINESS PAGE: B6 EDITION: METRO
SOURCE: Associated Press
DATELINE: LENGTH: Medium
Trigon Blue Cross Blue Shield, which recently paid nearly $30 million in fines and refunds to subscribers, has applied to the State Corporation Commission to become a for-profit public stock company.
Gilmore, who earlier in the day in U.S. District Court won the right to make public a report of his investigation and file it with the SCC, said he still has troubling questions about Trigon and its management practices.
``We believe there needs to be some demonstration of change so that the public, as this matter proceeds onward, can have some satisfaction that the new Trigon will behave better than the old one,'' he said.
``Going into court to try to suppress the giving of this information to the State Corporation Commission does not demonstrate that. It demonstrates the same type of approach that we have always seen from Trigon.''
The SCC must approve Trigon's proposed switch from a policyholder-owned insurance company to a public for-profit endeavour.
Trigon dismissed the 38-page report as a ``rehash of information that has previously been disclosed and dealt with.''
Trigon also claimed victory in the settlement of its lawsuit, saying its intent all along was to protect the privacy of employees who cooperated in the attorney general's investigation.
Trigon has refunded at least $23 million to subscribers and paid a $5 million fine to the SCC after an investigation showed savings from secret discounts arranged with hospitals had not been passed on to consumers.
Gilmore's report said Trigon used vague language on claim forms and a ``no-tell'' policy to confuse subscribers questioning the information.
The forms gave the original costs of services as the actual costs and made no mention of the discounts Trigon had arranged.
The report cited a case in which a man paid the required 20 percent, or $190, of a bill for $950 worth of services. The form showed Trigon had paid the other $760, when actually it paid $374.
Gilmore said the investigation showed Trigon employees were guilty of dismissing questions about the information on the forms as problems in semantics or chalking them up to common confusion about medical coverage.
The report quotes an unnamed member of the company's legal office as saying it never occurred to him to question the wording of the forms. ``I mean, it was like, `I got to get back to my real work,''' the worker said.
Gilmore said records of consumer complaints go back to the late 1970s, but he said he would support Trigon's switch to a for-profit stock company if the company changes its practices.``But I will not support it until I see there's some change of attitude, structure or accountability in management practices within the corporation.''
by CNB