Excellus Bluecross Blueshield will refund plan members who overpaid health care providers as a result of the insurance firm’s improper accounting of deductibles, according to settlement this week with the state Attorney General’s office.
The settlement also requires Excellus to properly account for members' deductible and out-of-pocket expenses to prevent similar improper denials of claims in the future.
“An insurance policy is a two-way street. New Yorkers who live up to their end of the bargain by paying their premiums and deductibles deserve to have their insurance company live up to its promises by properly paying their claims,” Attorney General Eric Schneiderman said, in a press release.
Some 12,000 customers will receive the refunds.
The settlement was the result of an independent investigation by the A.G. into Excellus's failure to properly track members' deductible and out-of-pocket expenditures into its automated claims.
In this case, Excellus failed to pay customers’ claims even after the required deductibles were met, according to the state.
State investigators said after Excellus wrongly denied claims, the providers either billed the customers for the cost of the services or absorbed the loss themselves.
Excellus reported the errors were the result of a technology glitch following modifications to its software. As a result of these computer errors, claims processed after Sept. 1, 2011, were erroneously denied for failure to satisfy a deductible that had, in fact, already been met.
Excellus told the A.G.’s office it has made payments totaling approximately $700,000 to customers who were owed less than $250 and another $2.4 million to customers owed more than $250, as well as to participating providers.
The insurer also has agreed to conduct outreach and ensure that all members who overpaid providers because of Excellus's accounting error receive restitution, and to audit and monitor its claims processing procedures to ensure these problems do not recur, according to the A.G.
Excellus has simultaneously entered into a stipulated agreement with the New York State Department of Financial Services relating to the same subject matter.
Excellus Bluecross Blueshield will refund plan members who overpaid health care providers as a result of the insurance firm’s improper accounting of deductibles, according to settlement this week with the state Attorney General’s office.
The settlement also requires Excellus to properly account for members' deductible and out-of-pocket expenses to prevent similar improper denials of claims in the future.
“An insurance policy is a two-way street. New Yorkers who live up to their end of the bargain by paying their premiums and deductibles deserve to have their insurance company live up to its promises by properly paying their claims,” Attorney General Eric Schneiderman said, in a press release.
Some 12,000 customers will receive the refunds.
The settlement was the result of an independent investigation by the A.G. into Excellus's failure to properly track members' deductible and out-of-pocket expenditures into its automated claims.
In this case, Excellus failed to pay customers’ claims even after the required deductibles were met, according to the state.
State investigators said after Excellus wrongly denied claims, the providers either billed the customers for the cost of the services or absorbed the loss themselves.
Excellus reported the errors were the result of a technology glitch following modifications to its software. As a result of these computer errors, claims processed after Sept. 1, 2011, were erroneously denied for failure to satisfy a deductible that had, in fact, already been met.
Excellus told the A.G.’s office it has made payments totaling approximately $700,000 to customers who were owed less than $250 and another $2.4 million to customers owed more than $250, as well as to participating providers.
The insurer also has agreed to conduct outreach and ensure that all members who overpaid providers because of Excellus's accounting error receive restitution, and to audit and monitor its claims processing procedures to ensure these problems do not recur, according to the A.G.
Excellus has simultaneously entered into a stipulated agreement with the New York State Department of Financial Services relating to the same subject matter.
