People across the state with health insurance from Excellus, including many in St. Lawrence County, could be getting a refund from the company.
State Attorney General Eric Schneiderman has announced a $3 million settlement with the company, formerly a non-profit Blue Cross/Blue Shield provider in New York, which he said improperly denied claims from 12,000 customers saying that customers' deductibles had not yet been met when in fact they were.
The company has made payments totaling approximately $3,100,000 to consumers and providers.
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.
The Attorney General's Health Care Bureau began looking into Excellus's failure to properly track members' deductible and out-of-pocket expenditures after receiving of customer complaints.
Health insurance policies generally require customers to pay out-of-pocket up to a fixed dollar amount -- their deductible -- after which the insurance carrier is obligated to pay for covered services. In this case, Excellus failed to pay customers’ claims even after the required deductibles were met.
After Excellus wrongly denied claims, providers either billed the customers for the cost of the services or absorbed the loss themselves. Excellus reported that these accounting errors -- which affected 12,000 customers -- were the result of a technology glitch following modifications to its software.
As a result of these computer errors, claims processed after Sep. 1, 2011, were erroneously denied for failure to satisfy a deductible that had, in fact, already been met.
Excellus's accounting errors primarily affected members covered under its high-deductible plans, the attorney general said.