Excellus repays $3M to members for improper accounting practices


Excellus Blue Cross Blue Shield has refunded $3.1 million to members who overpaid doctors because of the insurer's improper accounting practices.

New York Attorney General Eric Schneiderman announced the settlement Wednesday, explaining that Excellus wrongly denied more than 12,000 claims, most of which were for its high-deductible customers, because its claims system didn't accurately track deductibles and out-of-pocket expenses. That meant Excellus failed to pay members' claims, even after they met their deductibles, reported LifeHealthPro.

Excellus, however, quickly clarified that it didn't reimburse the $3.1 million as part of a settlement with the attorney general, but instead took the initiative to report the computer glitch, which it claimed caused the wrong denials, and rectified the problem on its own, the Rochester Democrat and Chronicle reported.

"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," Excellus said in a statement, according to the Associated Press. "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."    

But New York officials were concerned that the affected Excellus members didn't receive their refund checks because they were sent to the providers instead. Excellus Spokesperson Jim Redmond clarified that all refunds were made, some to providers and others to members, the Democrat and Chronicle noted.

To learn more:
- here's the attorney general's settlement statement
- see the LifeHealthPro article
- read the Rochester Democrat and Chronicle article
- check out the AP article

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