BCBSTX to repay consumers for emergency claims and marketing errors

Blue Cross Blue Shield of Texas (BCBSTX) has agreed to repay consumers after a Texas Department of Insurance (TDI) 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.

“Consumers who had higher out-of-pocket costs due to the errors will get refunds,” said Texas Insurance Commissioner Kent Sullivan. “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.

BCBSTX Enforcement Letter

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