Texas Attorney General Ken Paxton (R-Texas) opened an investigation into Blue Cross and Blue Shield of Texas over allegations that the insurer denied or delayed urgent care, including approval for a newborn’s transfer for treatment.
The inquiry also covers Health Care Service Corporation and related entities, Paxton’s office announced Monday. Blue Cross and Blue Shield of Texas, or BCBSTX, operates as a division of HCSC.
Newborn’s transfer draws scrutiny
Administrative denials and potentially improper utilization reviews delayed approval to transfer a newborn to a facility equipped to provide urgently needed care, the attorney general’s office alleged. The applicable health plan allegedly covered the procedure.
The release did not identify the infant, specify the treatment or say how long the approval took. Delays can worsen patients’ conditions, increase complications and administrative costs, and cause disability or death, the office said.
“Blue Cross Blue Shield has a responsibility to put patients before profits and ensure that Texans receive the care they need,” Paxton said in the release.
“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—not searching for ways to delay or deny it. I will wage a relentless legal battle against any insurance company that fails to protect health and safety of Texans.”
Claims review and prior authorization
Investigators will examine the insurer’s statements about approving and denying medically necessary claims, whether it rejects claims without adequate review, and potentially burdensome prior authorization requirements, the office said.
Paxton issued a civil investigative demand to obtain information and determine whether the companies violated Texas law, including the Texas Deceptive Trade Practices Act. The announcement describes an investigation, not a finding that the insurer broke the law.
Insurer explains its approval process
Prior authorization allows the insurer and outside vendors to review whether requested services or drugs meet medical-necessity and coverage requirements, BCBSTX explains in its public guide. Patients or their doctors can appeal a denial, the guide says.
That page describes the company’s general process and does not address Monday’s allegations. The attorney general’s announcement did not include a company response.
Paxton has also used the Deceptive Trade Practices Act in separate cases against Amazon and TikTok, as previously reported by The Dallas Express.
