Excellus to pay for wrongfully denying lead tests


Excellus Blue Cross Blue Shield on Thursday reached a settlement with the New York attorney general in which the insurer will provide refunds, plus interest, for childhood lead screening tests that it incorrectly denied its members.

"This settlement puts health insurance providers on notice that unlawful denials of mandated insurance coverage will not be tolerated by this office," New York Attorney General Eric Schneiderman said, reported the Utica Observer-Dispatch.

After Schneiderman's office began receiving complaints that Excellus was denying coverage for lead tests--which are required under New York state law--it conducted an investigation revealing that Excellus denied hundreds of "crucial, routine" lead tests between 2009 and 2011.

Despite member grievances of the denials, Excellus continued to deny the tests, which lead physician offices either to bill Excellus members directly or absorb the costs themselves.

Excellus has agreed to accurately process the lead test claims, fix problems in its claims system that led to the denials and refund its members who paid for screening tests out-of-pocket. It also will pay 12 percent interest of the test costs, Buffalo Business First reported.

The settlement also requires Excellus to provide employee training sessions about lead screening coverage and review all of its denials for childhood lead screening tests over a six-month period to determine if any were wrongfully denied, according to the Syracuse Post-Standard.

To learn more:
- read the Buffalo Business First article
- see the Utica Observer-Dispatch article
- check out the Syracuse Post-Standard article

Related Articles:
Outgoing Excellus CEO gets 173% increase in compensation

Health plan could save $1B per year with generic drugs
Excellus BCBS airs funny ads to cut avoidable ER visits