BCBS of Texas to reimburse out-of-network ER claims, pay $10M fine

Blue Cross Blue Shield of Texas agreed to reimburse members for out-of-network emergency claims due to delays and incorrect advertising, the Texas Department of Insurance said March 6.

A state review of BCBSTX's processing for out-of-network emergency claims and customer communications on ER claims found the insurer listed incorrect information about resolving balance bills for many members who received out-of-network ER care. The Texas Department of Insurance also found BCBSTX delayed processing out-of-network claims under a new review process the company started using in 2018, and included errors in marketing materials about the plans.

Texas Insurance Commissioner Kent Sullivan said BCBSTX customers who had higher out-of-pocket costs due to the errors will receive refunds. BCBSTX agreed to notify affected members by May 1.

The insurer will also pay a $10 million fine over the errors, the insurance department said.

More articles on payers:
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