business
Blues plan fined nearly $1 million for ED claims denials
NEWS IN BRIEF — Posted May 14, 2012
New York State’s Dept. of Financial Services fined Rochester, N.Y.-based Excellus BlueCross BlueShield $995,000 for improperly denying 166 emergency department claims and failing to send explanation of benefit notices to customers 337,689 times. The department’s April 19 news release said the violations occurred between 2003 and 2007. The company did not admit or deny wrongdoing.
In an agreement stipulating the terms of the fine, Excellus stated that the violations “were not the result of a company policy to evade the requirements of insurance law and regulations.” The company has paid the fine, reimbursed the members whose emergency department claims were improperly denied, and agreed to take all necessary steps to prevent the problems from happening again.
“As the superintendent noted, we’ve been working with the department to address any outstanding issues,” said Jim Redmond, vice president of communications and community investments at Excellus. “The health plan, meanwhile, is committed to retaining national recognition for providing high-quality services at lower than average costs.”
Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/05/14/bibf0514.htm.
