Blue Cross/Blue Shield, MN reach agreement
Blue Cross/Blue Shield, MN reach agreement
Blue Cross and Blue Shield of Minnesota (BCBSM), based in St. Paul, has agreed to allow an independent review committee to oversee its coverage decisions as part of a larger settlement with the state attorney general. Officials of the Minnesota Blues plan and Attorney General Mike Hatch said the pact resolves allegations that the insurer routinely denied medically necessary treatment for children and young adults suffering from mental illness, eating disorders, and chemical dependency. In addition to the pact, BCBSM agreed to pay $8.2 million to resolve claims owed to the state of Minnesota.
Mark Banks, MD, president and CEO of BCBSM, says the state’s lawsuit "compelled us to move more aggressively and quickly on steps we were taking to build a better system of care for those with mental health and eating disorders, autism, and chemical dependency."
According to the settlement, the health plan and the state will create a three-member committee to independently review certain mental health and chemical dependency claims denied by Blue Cross. The attorney general also may appoint an auditor to review BCBSM’s books, records and personnel every six months and to assess the company’s information flow with respect to mental health benefits.
The plan also must pay for treatment ordered by a court of law as long as that treatment is based on the evaluation and recommendation of a physician, licensed psychologist, or other specified health professional.
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