Texas Insurance Regulators: BCBSTX to Pay Restitution, $10M Fine for Claims, Marketing Errors

The Texas Department of Insurance (TDI) said Blue Cross Blue Shield of Texas (BCBSTX) has agreed to repay consumers after a departmental review found delays in handling out-of-network emergency claims and incorrect information in consumer notices and marketing materials.

BCBSTX also will pay a $10 million fine, TDI said.

“Consumers who had higher out-of-pocket costs due to the errors will get refunds,” Texas Insurance Commissioner Kent Sullivan said in a media announcement. “Ensuring the fair treatment of consumers and clear, timely consumer information are priorities for TDI.”

Based on a review of BCBSTX communications and how it processed out-of-network emergency claims, TDI found:

• Incorrect information about how to resolve balance bills on explanations of benefits for many HMO members who received out-of-network emergency care.
• Delays in processing out-of-network claims that went through an Emergency Benefit Management review process the company began using in August 2018.
• Errors in marketing materials about plans offered in 2018 and 2019.

BCBSTX agreed to begin sending the consumer notices by May 1. Consumers with questions should call the number on their BCBSTX ID cards for member information.

The BCBSTX enforcement order may be found online at: https://www.tdi.texas.gov/orders/documents/20206281.pdf.

Source: TDI