California's managed healthcare department fined Blue Shield of California $200,000 for mishandling provider claims.
According to a Dec. 13 news release from the department, a Blue Shield of California member received out-of-network treatment for gender dysphoria between March and December 2021. Blue Shield of California authorized the out-of-network treatment but incorrectly adjusted some claims payments from the provider. The incorrect payments led the provider to stop treating the member.
The member reported the denials to Blue Shield of California, which did not address the concerns in accordance with state law, according to the news release. After the member reported the denials to the state, the department of managed healthcare found 13 provider claims processed incorrectly related to the member who made the complaint, and eight additional incorrect claims affecting other members.
Blue Shield of California has paid the fine and implemented corrective actions to improve its claims handling, the department of managed healthcare said.
"Blue Shield of California is committed to providing access to quality care for our members and processing provider claims timely and accurately," a spokesperson said in a statement to Becker's. "We respect the findings of the Department of Managed Health Care investigation in this matter, and took swift action to improve related internal processes, employee training and procedures upon learning of the situation."