Texas Attorney General Ken Paxton launched an investigation into Blue Cross and Blue Shield of Texas and its parent company, Health Care Service Corp., over potential denials and delays of medically necessary care, as well as prior authorization concerns.
Mr. Paxton’s office announced the investigation Sept. 28. The office received reports that pointed to BCBS Texas possibly putting off medically necessary or urgent care. The attorney general’s news release said delays in approving medically urgent treatment can result in worsening conditions, complication risks, disability, death and steeper administrative costs.
One reported situation involved a newborn in need of urgent treatment. While the procedure was allegedly covered, administrative denials and possible utilization review issues delayed approval of the newborn’s transfer to a facility capable of giving the needed care, the release said.
Mr. Paxton will assess whether claim denials have happened without sufficient review or if the companies partook in other unlawful behaviors. He issued a Civil Investigative Demand to learn more about whether BCBS Texas, HCSC or related businesses broke state law.
BCBS Texas told Becker’s Sept. 29 that it does not comment on investigations.
In February, Mr. Paxton’s team said it had kicked off a separate investigation into BCBS Texas and business services provider Conduent following a data breach.
Becker’s has reached out to HCSC for comment and will update this story if more information becomes available.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
