Attorney General Ken Paxton has opened an investigation into Blue Cross Blue Shield of Texas, its parent company Health Care Service Corporation and related businesses over how the insurer approves and denies urgent and medically necessary care, his office announced September 28. The office issued a civil investigative demand for records to determine whether the companies violated Texas law, including the Deceptive Trade Practices Act.
One case reported to the office involved a newborn who needed urgent treatment. According to the release, the procedure was “allegedly covered under the applicable health plan,” but administrative denials and “potentially improper utilization review procedures” delayed approval of the baby’s transfer to a facility that could provide the care. The office said reports it has received indicate the insurer “may have denied or delayed coverage for procedures deemed medically necessary or urgent.”
“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,” Paxton said.
The investigation will focus on what the insurer has told consumers about approving and denying claims, and on whether it denies claims without adequate review. Blue Cross Blue Shield of Texas declined to comment on the investigation, KXAN reported. The attorney general’s office has announced no charge or finding.
Texas has written its own rules for how insurers approve care in advance. House Bill 3459, which took effect September 1, 2021, set preauthorization requirements for certain health care services and rules for utilization review in some health plans. It was carried by Rep. Greg Bonnen in the House and Sen. Dawn Buckingham in the Senate.
The demand for records comes from a Texas office under a Texas consumer-protection statute. What it turns up will be weighed under Texas law.
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