Delaware’s big health insurance company is facing a big fine.
Blue Cross Blue Shield of Delaware will pay $325,000 to the state after an Insurance Department investigation.
Commissioner Karen Weldin Stewart said the company broke the law by denying claims for high-tech imaging tests for the heart. More than 120 patients got a stress test, she said, but their doctors didn’t get paid.
“When the doctors went back to get paid, they were denied, and in Delaware we do have laws that say you must get paid for what is called a ‘clean claim,’ which these were, because they were already preapproved,” Stewart said.
Blue Cross acknowledged errors in processing claims, but rejected the idea that the company violated state law.
Blue Cross will also pay for a program from the American College of Cardiology to better educate Delaware doctors.
“Because imaging is such a rapidly changing and evolving field it’s very difficult for busy practitioners to know all of the indications and all the situations in which a patient might require imaging or what type of imaging they might benefit from the most,” said Dr. Janet Wright, senior vice president for science and quality.
The program helps doctors match patients with the right test the first time around.