Blue Cross, still dealing with system failure issues, may drop ObamaCare marketplace

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RALEIGH, N.C. (WNCN) – Blue Cross Blue Shield of North Carolina and its customers have had a rocky start to 2016 due to the insurance company’s system failure. Now, with rising healthcare costs under President Barack Obama’s signature legislation, BCBSNC is considering getting out of the Affordable Care Act marketplace.

Brad Wilson, BCBSNC’s CEO, tells CBS North Carolina that the cost of offering plans under the Affordable Care Act in every county in the state is unsustainable.

“We do not take this analysis, which we must undertake, lightly at all,” Wilson said. “It is clear that changes need to be made.”

CEO Brad Wilson of Blue Cross Blue Shield of North Carolina (CBS North Carolina)

Blue Cross Blue Shield of North Carolina, the state’s largest insurer, could decide to change the plans that are offered, try to get federal regulators to improve the system or get out of the ACA marketplace altogether.

“We can’t continue to offer all that we’re offering if the net result is a $282 million loss year over year over year,” Wilson said.

Insurance rates have jumped as Blue Cross struggles to break even.

“It’s obscene,” said customer Kerry Occhino. “Honestly, it would be cheaper for us to just pay everything out of pocket.”

Blue Cross has also taken heat for significant pay raises for executives during the financial crisis. Wilson’s pay jumped about a third to nearly $3.8 million last year.

“Our board takes all compensation, not just executive compensation, very seriously,” Wilson said. “They make the judgment not only about performance but at the levels that everyone in our company should be paid in order to attract and retain the appropriate talent.”

As for the system failure at the first of the year, Wilson said that the problems were not anticipated and the company is sorry for the issues they caused customers.

“Well, we certainly didn’t anticipate what happened, happening. So, let me start there,” Wilson said. “We certainly understand the difficulties that it’s presented to our customers. We apologize for that.”

The system failure at Blue Cross Blue Shield of North Carolina offices created problems for customers, from resolving billing issue to even getting access to health care.

Wilson said there were backup systems in place but they weren’t good enough.

“I tried four times anywhere from an hour to two hours without even getting a live person,” said customer Peter Cusden.

Customer Ann McConnell stayed with it even longer. “I stayed on hold 20 hours and probably spent another 10 to 15 talking,” she said.

CBS North Carolina obtained nearly a thousand pages worth of emails from the State Department of Insurance as the crisis unfolded. They show state employees trained to deal with these problems found some of the responses from BCBSNC “very frustrating and confusing.” To make matters worse, some customers received an incorrect number to call to resolve their billing issues.

“We certainly didn’t anticipate and understand the avalanche, is the term that I would use, right at the outset,” Wilson said.

Since the crisis began, the Department of Insurance has extra staff trying to help customers and Blue Cross Blue Shield has trained more people to handle calls.

But some customers are still having trouble.

“Any customer who has suffered any financial loss, we have and will continue to make whole,” Wilson said. “An apology, I know, doesn’t make them feel a whole lot better if they were inconvenienced as a result of having a missed appointment or didn’t get a prescription filled timely. What is appropriate is for us to intervene on their behalf to get them that appointment again or make sure that prescription can be filled and will continue to be filled.”

Wilson said things should return to normal in a matter of weeks. “Our response could have been faster,” he said. “We wished it had been. But, I can tell you it wasn’t for the lack of trying.”

The N.C. Department of Insurance is onsite at Blue Cross Blue Shield of North Carolina to investigate the system failure. Wayne Goodwin, the state’s insurance commissioner, said that Blue Cross could face fines up to $1,000 per day per violation that investigators find.

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