DOI Issues Another Hefty Fine to Insurance Company for Violating the ISMS-Initiated NAT Act

October 28, 2022

Last week the Illinois Department of Insurance (IDOI) fined Celtic Insurance Company $1.25 million for violating Illinois’ Network Adequacy and Transparency Act (NAT Act) and the federal Mental Health Parity and Addiction Equity Act (MHPAEA).

The DOI’s market conduct exam performed from 2018 to 2020 found these violations by Celtic:

  • The NAT Act, initiated by ISMS, took effect Jan. 1, 2019, and mandates health insurance carriers to maintain an adequate network of providers. Celtic violated the NAT Act by failing to provide an up-to-date, accurate provider directory. The health insurer also did not follow the proper time/distance standards as required by this law. An adequate network of physicians is essential to patient access to care!
  •  MHPAEA requires health insurance plans to have equivalent levels of coverage for mental health and substance use disorder care as for medical or surgical care. Celtic failed to be in compliance with this federal law.

Celtic is a subsidiary of Centene Corporation.

In March 2022, the IDOI assessed a fine of $339,000 to the parent company of Blue Cross Blue Shield of Illinois (BCBSIL) for NAT Act violations. This was the first time ever that the IDOI fined an insurer under this Act.

Fines to Celtic and BCBSIL are a direct result of ISMS advocacy to enact the NAT Act.

If you believe a health insurance company is violating the NAT Act or any other law or regulation, please file a complaint with the DOI. When appropriate, encourage your patients to also file complaints. These complaints drive the DOI to take action. Need help? Contact the DOI’s Office of Consumer Health Insurance toll free at 877-527-9431.

To learn more, access ISMS’ resource Health Insurance Complaints? The Department of Insurance Needs to Know.

Questions? Please contact the ISMS Health Policy Research and Advocacy team by email.

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