Yup, after an investigation into complaints that Excellus BlueCross BlueShield was denying health insurance coverage, the New York Attorney General’s Office has settled with the health insurance giant after finding that it had denied hundreds of claims for lead screening tests. The settlement with Excellus BlueCross BlueShield requires the health insurer to accurately process claims for these routine — and crucial — tests. The settlement also requires Excellus BlueCross BlueShield to fix its faulty claims system and provide refunds to consumers who paid for lead screening tests out-of-pocket after initially being denied.
The New York Attorney General’s Office began looking into Excellus BlueCross BlueShield’s practices after it started receiving complaints about claim denials through its Health Care Bureau Helpline. The investigation uncovered Excellus BlueCross BlueShield’s denials of hundreds of childhood lead screening claims over a two-year period beginning in August 2009 through September 2011. Even when plan members filed grievances with Excellus BlueCross BlueShield, disputing the denials, Excellus BlueCross BlueShield staff did not fix the problem. Once the claims were denied, physician’s offices either billed the consumers for the cost of the test, or absorbed the loss themselves.
Lead poisoning causes serious neurological harm in children, including developmental delays, learning disabilities, hearing loss, intellectual impairment, short stature and other health problems.New York State law requires insurance coverage of lead screening for children ages one and two to promote early detection through screening and ensure that treatment begins before severe and irreversible damage is done.
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