Oxendine Orders Blue Cross to Reimburse $12 Million

Insurance Commissioner John W. Oxendine announced today that he has ordered Blue Cross and Blue Shield of Georgia, Inc. to make additional claims payments of $12 million for certain ambulance services rendered to its policyholders that were improperly reimbursed.

The consent order is the result of a market conduct exam initiated by Oxendine’s office which revealed that Blue Cross incorrectly reimbursed out-of-network ambulance providers for services rendered. In a number of instances, Blue Cross made inconsistent payments for comparable ambulance services. In other cases, Blue Cross failed to increase its reimbursement rates over a number of years, in spite of the increasing costs of providing ambulance services.

“The proper payment of claims for emergency services is vital to the maintenance of our trauma system and equally important to protect consumers from excessive balance billing. I want insurers to know that I expect providers to be paid according to the requirements of Georgia law,” Oxendine said.

As a result of this action, Blue Cross has also been ordered to increase reimbursement rates for future out-of-network ambulance services. “Resolving prior practices is only part of the solution,” Oxendine said. “We must ensure that insurance companies reimburse medical providers and policyholders in a fair and equitable manner.”
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