Blues plan fined nearly $1 million for ED claims denials

NEWS IN BRIEF — Posted May 14, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

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

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn