Texas Attorney General Ken Paxton has launched an investigation into Blue Cross Blue Shield of Texas, its parent company Health Care Service Corporation, and related entities, alleging they have denied and delayed urgent and medically necessary care.
The investigation is based on the company's procedures for denying and delaying urgent and medically necessary care and its potentially burdensome prior authorization requirements, according to the attorney general's office. Reports received by the office indicate that the company may have denied or delayed coverage for procedures deemed medically necessary or urgent.
One documented case involved a newborn requiring urgent medical treatment. Although the procedure was allegedly covered under the applicable health plan, administrative denials and potentially improper utilization review procedures delayed approval of a transfer to a facility capable of providing the necessary care.
Delays in approving medically urgent treatment can worsen a patient's condition, increase the risk of complications, allow disease progression, cause disability or death, and increase administrative costs, according to the office.
The investigation will focus on representations made by the company regarding its approval and denial of medically necessary claims. The attorney general is seeking to determine whether claims are denied without adequate review or whether the company engages in any other unlawful practices. Paxton has issued a Civil Investigative Demand to obtain information and determine whether the entities violated Texas law, including the Texas Deceptive Trade Practices Act.