KNOX COUNTY HOSPITAL DISTRICT

BLUE CROSS BLUE SHIELD $10 MILLION FINE DESERVES FURTHER SCRUTINY

Attorneys for Knox County Hospital say the state’s $10 million fine of Blue Cross Blue Shield (BCBS) for mishandling out-of-network emergency claims and providing incorrect information to consumers demonstrates that a much broader review of BCBS is merited. The Texas Department of Insurance (TDI) announced Friday that the fine reflects that there were significant issues including violation of the state’s prompt payment statute. The insurance giant was also ordered to pay restitution to consumers harmed by its actions. BCBS has agreed to pay the fine within 30 days and complete restitution payments by the end of the year. This agreed to TDI’s order after TDI conducted a market conduct examination on BCBS from January 1, and ending in September 30, 2018.

“There is no doubt other entities that have been harmed by this chronic callous treatment. Clearly, the pattern of behavior by BCBS merits a broader review by TDI,” said Kelly Dawson attorney for Knox County Hospital. “BCBS owes Knox County Hospital more than $20 million in unpaid claims. Although we are seeking relief in federal court, the state remains responsible for regulating BCBS” added Dawson. This is the same pattern of conduct TDI found BCBS in violation of. As cited by the order, BCBS has a system programming error which caused the issues. This is not unlike what was told to Knox.”

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