Sanford Health found non-compliant in nine areas according to ND agency

Photo by: WDAY Radio File (Canva)
Photo by: WDAY Radio File (Canva)

(Fargo, ND) -- The North Dakota Insurance Department's latest audit found that Sanford Health is non-compliant in nine areas.

State Insurance Commissioner Jon Godfread says the examination is routine, as state lawmakers passed a law requiring the Insurance Department to examine carriers that cover 25% or more of the market. This is a first-time examination for Sanford Health.

The essential function of the North Dakota Insurance Department is to ensure that consumers are treated fairly and respectfully by their insurance company,” said Insurance Commissioner Jon Godfread. “A market conduct examination is a way of looking at specific cases to see how consumers have been treated and if the law was followed.”

The nine areas where Sanford was non-compliant included claims processing, mental and behavioral health substance abuse claims, comparative analysis for Non-Quantitative Treatment Limitations (NQTLs) and Quantitative Treatment Limitations (QTLs) associated with the Mental Health Parity and Addiction Equity Act (MHPAEA), Telehealth service coverage and claims, Independent review procedures, coordination of benefits with auto insurance, Medicare Suppliment products, Insurance fraud reporting, and Pharmacy Benefit Management contracts. 

Sanford Health Plan has issued a statement in response: "Sanford Health Plan is committed to providing high-quality insurance coverage for the members we serve. Since the end of the market conduct exam, we have resolved most of the findings in question, and the remaining will be resolved shortly. We are grateful for the efforts of the North Dakota Insurance Department and the collaborative nature in which it conducted this comprehensive market conduct exam of years 2016-2020."

You can read a full copy of the report by clicking here