The Pennsylvania Insurance Department ordered Capital Blue Cross to pay restitution plus interest for wrongly denied claims, in addition to an $85,000 fine, pennlive.com reported Jan. 4.
The department found that Capital denied some claims for lack of prior authorization when authorization had already been given, failing to clearly communicate with some members and incorrectly imposing limits on some mental health-related claims, according to the report.
The violations occurred between Jan. 1, 2017, and March 31, 2018, according to the report. The violations were found during a regular examination conducted by the department.
It is still unknown how many customers are affected or the total amount of restitution Capital will be required to pay, according to the report. An insurance department spokesperson told the news outlet it may take some time for Capital to identify all claims and members impacted.
Capital said in a statement to pennlive.com that it continually evaluates its operations and procedures and appreciates the department's "thorough and thoughtful review of our efforts." The company said it has already taken action to address the issues noted in the examination.