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Excellus Health Plan settlement may result in refunds

By Mark Payne | Jan 14, 2015

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ALBANY, N.Y. (Legal Newsline) - Excellus Health Plan, Inc. agreed to a settlement with New York Attorney General Eric Schneiderman on Monday that may require its contracted providers to issue refunds of approximately $74,000 after allegedly overcharging patients for copays.

The settlement followed a complaint filed on the attorney general's Health Care Bureau Helpline from a patient who alleged he was billed for a specialty copayment of $25 for a visit to his primary care physician, who he had already given a $15 copay to.


Excellus admitted that it had sent patients incorrect Explanation of Benefits, which wrongly tacked on specialty care copays for visits to health care providers affiliated with the University of Rochester Medical Center. The insurance provider said the error occurred when the physician offices changed tax ID numbers, causing the Excellus' claims processing system to default to the higher copayments when it couldn't match the new tax ID numbers to primary care physicians. 

“Many New Yorkers spend a significant portion of their income on health insurance, and it’s critical that their claims are billed and processed correctly,” Schneiderman said. “Patients shouldn’t have to pay for mistakes made by providers and health insurers.”

Excellus has identified 2,973 primary care claims that may require refunds. 

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