Texas Attorney General Ken Paxton investigates Blue Cross Blue Shield over coverage denials for urgent care
Texas Attorney General Ken Paxton opened an investigation on Sept. 28 into Blue Cross Blue Shield of Texas and its parent company, Health Care Service Corporation, over allegations that Blue Cross Blue Shield of Texas denied or delayed coverage for medically necessary and urgent care.
The investigation follows complaints submitted to the Office of the Attorney General alleging that the prior authorization and utilization review procedures of Blue Cross Blue Shield of Texas caused delays in approving treatment. One case involved a newborn who needed urgent medical care and whose transfer to a facility equipped to treat the baby was reportedly delayed by administrative denials, despite the procedure allegedly being covered under the family's health plan.
The attorney general's office said delays in urgent treatment could worsen patients' conditions, increase the risk of complications, allow diseases to progress and potentially result in disability or death. Such delays may also increase administrative costs, the office said.
"Blue Cross Blue Shield has a responsibility to put patients before profits and ensure that Texans receive the care they need," Paxton said. "When a newborn baby or any other Texan urgently needs medical treatment, an insurance company's priority should be helping provide that care to the best of its ability, not searching for ways to delay or deny it."
The investigation will examine how Blue Cross Blue Shield of Texas represents its approval and denial of medically necessary claims, including whether claims were rejected without adequate review or whether Blue Cross Blue Shield of Texas and Health Care Service Corporation engaged in other unlawful practices.
As part of the investigation, Paxton issued a Civil Investigative Demand seeking information to determine whether Blue Cross Blue Shield of Texas, Health Care Service Corporation or related entities violated Texas law, including the Texas Deceptive Trade Practices Act.
