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Schneiderman Gets $3M Settlement With Excellus

Posted By Joseph Spector On November 28, 2012 @ 2:54 pm In Other | Comments Disabled

Attorney General Eric Schneiderman announced a $3 million settlement today with Excellus Bluecross Blueshield for refunds on 12,000 wrongly denied claims, Gannett’s Haley Viccaro reports.

[1]Customers were billed for not meeting their deductibles even though they were paid to the insurer, he said. Excellus has made payments of about $3.1 million to consumers and providers who were wrongly billed, Schneiderman said. Excellus, based in Rochester, operates through upstate New York.

“An insurance policy is a two-way street,” Schneiderman said in a statement. “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.”

Excellus failed to properly track deductibles and expenditures of members and also failed to pay claims after deductibles were met, Schneiderman said.

Excellus said the errors were due to a technology glitch after making modifications to their software. Claims that were processed after Sept. 1 were denied as failing to meet the deductible due to these computer errors.

Excellus said they paid a total of $700,000 for costumers who owed less than $250 and $2,400,000 to customers who owed more than $250. Excellus plans to continue monitoring its claims procedures to prevent similar problems in the future.

“Excellus has reimbursed the individuals who were affected and has corrected the computer software problem which caused some of its members, particularly those with high deductible plans, to be overcharged,” Schneiderman said in a statement.

Following an investigation by the Attorney General’s Health Care Bureau, the settlement will also require Excellus to account for deductibles and out-of-pocket expenses to prevent future cases of improper denials.

Excellus spokesman Jim Redmond told the Democrat and Chronicle [2] that the company repaid subscribers voluntarily last year when it discovered that a new computer system had miscounted patient payments.

“We told the state ourselves when we discovered the problem,” Redmond said. “When the computer problem occurred, we proactively made sure we took all steps necessary to ensure our members’ claims were properly paid.”


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[1] Image: http://statepolitics.lohudblogs.com/files/2012/11/schneiderman11.jpg

[2] Excellus spokesman Jim Redmond told the Democrat and Chronicle: http://www.democratandchronicle.com/article/20121128/BUSINESS/311280038/-1/nletter03?source=nletter-business&nclick_check=1