NY attorney general says Excellus BC BS to refund $3.1M
Posted at: 11/29/2012 6:28 AM
By: Associated Press | WHEC.com
New York Attorney General Eric Schneiderman has announced a $3.1 million refund settlement with insurer Excellus BlueCross BlueShield for patients and health care providers who overpaid due to improper accounting of deductibles.
Schneiderman's office says Excellus has so far made repayments totaling $3.1 million. Excellus reported that accounting errors affecting 12,000 customers processed after September 1, 2011, followed software modifications with glitches that have since been repaired.
Schneiderman's Health Care Bureau started investigating Excellus's failure to properly track members' deductible and out-of-pocket expenditures into its automated claims system after receiving customer complaints.
Excellus BC BS issued a statement saying, "From the time we discovered that our computer system was miscalculating some of our members' deductibles, we have worked to make our customers financially whole. We were addressing this long before discussions with the attorney general. In fact, we self-reported the problem to the state in the first place.
We'd like the record to reflect that the agreements reached with the state are not a "$3 million settlement" that some headlines have suggested. That dollar reference includes the claims payments we already made to our customers with interest that we acted upon ourselves. When the computer problem occurred, we proactively made sure we took all steps necessary to ensure our members' claims were properly paid.
We conducted a thorough review of claims for every potentially impacted member to make sure their deductible totals and related claim payments were corrected. We also communicated with members, providers, employer groups, and state regulators about the steps we were taking to fix the problem.
This particular effort involves members impacted by the fall 2011 deductible accumulator issue. We will be sending a letter to each of these members in early January with claims details and instructions on how to obtain further assistance if they believe they have an unresolved claim. Our members do not need to take any action at this time.
We apologize for the problems the accumulator issue has caused for our members and providers."