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Blue Cross Blue Shield of Texas agrees to repay customer ER claims, marketing errors

BCBSTX will begin sending notices to customers beginning May 1.
Credit: WFAA
Blue Cross Blue Shield

Blue Cross Blue Shield of Texas announced Friday it will pay restitution to customers who paid balance bills for out-of-network emergency claims based on incorrect information in marketing materials. 

"Consumers who had higher out-of-pocket costs due to the errors will get refunds," Texas Insurance Commissioner Kent Sullivan said in a written statement. "Ensuring the fair treatment of consumers and clear, timely consumer information are priorities for TDI."

The Texas Department of Insurance says it found the following after conducting a review on BCBSTX: 

  • 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 will begin sending notices to customers beginning May 1. 

In addition to issuing refunds, BCBSTX has also agreed to pay a $10 million fine, officials say.

Anyone with questions is advised to call the number on their BCBSTX ID cards for member information.

According to the TDI website, the following customers are eligible for a refund: 

Current or former BCBSTX members in fully insured HMO plans, including Affordable Care Act plans, who received out-of-network emergency care between Aug. 1, 2017, and Dec. 31, 2019, and who paid or have an unresolved balance bill for that care.

Current or former fully insured BCBSTX members enrolled in certain 2018 or 2019 plans who had higher out-of-pocket costs based on information in plan documents provided by BCBSTX.

Additional refund details can be found here. 

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