Excellus Health Plan has entered into a settlement requiring its contracted healthcare providers to issue refunds for excessive co-payments to 2,973 Excellus members in the state of New York, according to an announcement by New York Attorney General Eric T. Schneiderman.
The investigation into Excellus began after the Attorney General's Health Care Bureau received a complaint regarding a member being charged a specialty care co-payment and a primary care co-payment for visiting his healthcare provider. The investigation revealed many Excellus members had been provided incorrect explanations of benefits, which Excellus admitted had been issued erroneously, according to the report.
Excellus explained the error occurred when certain providers who had changed their tax identification numbers submitted claims for processing, which prevented the claims from being matched to a primary care provider. Without a matching provider, Excellus said the claims "defaulted to the higher co-payment," according to the report.
"Many New Yorkers spend a significant portion of their income on health insurance, and it's critical that their clams are billed and processed correctly," said Attorney General Schneiderman. "Patients shouldn't have to pay for mistakes by providers and health insurers."
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