The Georgia state commissioner’s office has ordered Blue Cross Blue Cross Shield of Georgia Inc. to pay additional claims of $12 million to policyholders for ambulance services, according to the Dawson Times, a local paper in Georgia.
A market conduct exam revealed Blue Cross incorrectly reimbursed out-of-network service providers, and made inconsistent payments for comparable services. The insurer also failed to increase its reimbursement rates as service costs rose.
“The proper payment of claims for emergency services is vital to the maintenance of our trauma system and equally important to protect consumers from excessive balance billing,” the paper quotes Commissioner John Oxendine. “I want insurers to know that I expect providers to be paid according to the requirements of Georgia law.”