The office of New York Attorney General Eric Schneiderman today announced a $3.1 million settlement with Excellus Bluecross Blueshield.
The settlement requires the insurer to pay refunds plan members. Officials say the members overpaid health care providers as a result of improper accounting for deductibles at Excellus. Excellus said the accounting problems were due to a technology glitch.
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.
Excellus has simultaneously entered into a stipulated agreement with the New York State Department of Financial Services (DFS) relating to the same allegations.
After Excellus denied claims, providers either billed the customers for the cost of the services or absorbed the losses themselves.
Excellus reported that these accounting errors – which affected 12,000 customers – were the result of a technology glitch that occurred after the company modified its software, according to the attorney general's office.
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' accounting errors primarily affected members covered under high-deductible plans.
Excellus already has reimbursed the individuals who were affected and has corrected the computer software problem which caused some members to be overcharged, officials said.
