Excellus Settles Bad Faith Insurance Lawsuit with NY Attorney General
Insurance provider Excellus BlueCross BlueShield has agreed to a settlement with New York Attorney General Eric T. Schneiderman that will require it to stop acting in bad faith and unfairly denying childhood lead screening tests that have the potential to save lives.
Schneiderman announced the settlement this week, and added that it had followed an investigation by the Health Care Bureau that was spurred by consumer complaints about questionable denials by Excellus. The investigation found that hundreds of childhood lead screening claims were denied by the insurance company between August 2009 and September 2011.
The investigation also found that Excellus staff did not work properly to handle disputes when they were raised by customers. Once the claims by the insurer were denied, physician’s offices either billed the consumers for the cost of the test, or absorbed the loss themselves.
As part of the settlement, Excellus must now accurately process claims for lead screening tests, which are routine in nature and not usually denied by insurance plans. The settlement will also require that Excellus fixes its claims system, and refund consumers who unfairly paid for lead screening tests after their initial denial.
"Childhood lead screening tests are vital to protect public health, and today's settlement will ensure that Excellus will follow the law and cover these crucial, routine lead tests for children in our state," said Schneiderman. "This settlement puts health insurance providers on notice that unlawful denials of mandated insurance coverage will not be tolerated by this office."