It identified this right in the article that an automated system was not working! What was missed were amounts of member deductibles and out of pocket expenditures. I had a friend ask me a question related to double admissions charges the other day, somewhat similar with an amount not getting properly credited. Excellus Blue Cross said it was a technology glitch, I call those in cases like this, one more chapter in the Attack of the Killer Algorithms:)
In reading this too would you not know those with the high deductible plans got hit. To rectify what this algorithm didn’t perform they refunded $700,000 to customers owed less than $250 and $2.4 million who were owed more than that amount. as well as reimbursing doctors. We know the tune pretty much anymore with errors as it goes today, don’t count on customer service to help you sometimes either as they can be just as lost today in trying to get your answer. In this case nothing got done until the NY Attorney General stepped in it looks like so again algorithms in accounting doing their thing and not good for the consumers and doctors. Nice that this was settled but consumers don’t have that long to wait today as we don’t make as much money and all the flaws that corporate America are on our backs, ticket and time to resolve anymore. On an unrelated issue I’m still figuring this one out to where some automated algorithm did some data mining and auto added the new owners of my house as a second driver not too long ago. We still need to tax those data sellers. BD
Insurance Company Data Mining With Automated Transactions? What Is Being Done With Consumer Data–My Flawed Corporate America Data Shows Up -Attack of the Killer Algorithms Chapter 45
NEW YORK – Last week New York Attorney General Eric T. Schneiderman announced a $3.1 million settlement with Excellus BlueCross BlueShield requiring the insurer to refund 12,000 plan members who overpaid their healthcare providers as a result of the company’s improper accounting of deductibles.
According to the press release, the attorney general's Health Care Bureau began an independent investigation into Excellus' failure to properly track members' deductibles and out-of-pocket expenditures into its automated claims system following the receipt of customer complaints.