The NYS Attorney General’s Office has announced an agreement with Excellus Health Plan, which will require refunds to be issued to thousands of customers for what the state says were excessive copays.
When Eric Schneiderman's office inquired about the matter, Excellus acknowledged that it issued the Explanations of Benefits erroneously. The investigation began after an Excellus member complained that his provider billed him for specialty care after he already paid the primary care co-pay.
Excellus explained that certain providers affiliated with the University of Rochester Medical Center (URMC) had changed their tax identification numbers without informing Excellus. When the providers’ claims were submitted to Excellus after the tax identification number change, the Excellus claim processing system could not match the claims to the primary care provider and instead defaulted to the higher copayment.
Excellus has identified nearly 3,000 primary care claims that are involved, which could result in refunds of about $74,000 for consumers.
As part of the agreement, Excellus will take several steps including reviewing claims data and monitoring the refund process undertaken by URMC.
Excellus spokesman Jim Redmond issued this statement:
"All of the members involved were identified and sent letters back in November. Any adjustments that needed to be made on our end have already been completed. We are monitoring now to assure the refunds from the providers are forth coming."
