Risk Managers

Blue Cross and Blue Shield of Texas, A Division of Health Care Service Corporation of Chicago, IL
Order Number: 080514
Date of Order:  6/13/2008
Order Final In:   June
Action Taken:  $250,000 fine with additional fine of $3,900,000 subject to possible dollar-for-dollar reduction to zero by restitution paid
Violation:  Failed to make non-preferred benefits reasonably available to its insureds; Failed to maintain an accurate listing of its preferred providers

Editor’s Note: PPO networks change almost daily. So how does one maintain an accurate listing of its preferred providers?

http://www.txhealthpool.com/Financial%20Resources%20Table%20CURRENT.pdf

Effective October 1, 2008 Medicare will stop reimbursing healthcare providers for 11 “never events” – considered reasonably preventable errors in healthcare delivery. 

Editor’s Note: Does your health plan pay for Never Events? If so, how much did that cost your plan last year?