DFS puts Excellus in the dog house.

Posted April, 20 2012 by arianne

Yesterday, the NYS Department of Financial Services (DFS) announced that they had fined Rochester-based Excellus Health Plan $995,000 for violation of several insurance laws.

Apparently, between 2003 and 2007, the company improperly denied 166 emergency room claims and failed to explain coverage to plan members in 337,689 instances.  Excellus has stated that the denied claims had to do with a computer error and that consumers have since been reimbursed for these improperly denied claims. They didn’t seem to have a good excuse as to why they never sent an explanation of benefits to the other 337,689 folks, and what effect that had, suffice to say that all but a few claims in those cases were covered.

Kudos to the DFS for catching these big errors! Hopefully it will give our insurance plans a better incentive to make sure that nobody else is asleep at the switch in the ol’ quality control department.

Click here to view the DFS press release on the matter.

Click here to view the stipulation signed by Excellus in agreeing to correct the violations.