The insurance department didn't say how many people are affected; Capital calls it the 'lowest penalty.'
A Dauphin County-based health insurer must pay restitution plus interest for wrongly denied claims, the state insurance department said Wednesday.The insurance department faulted Capital for violations including denying some claims for lack of prior authorization when authorization had already been given, failing to clearly communicate with some members, and incorrectly imposing limits on some mental health-related claims.
Capital said in a written statement it is “pleased that the Pennsylvania Insurance Department’s recent comprehensive Affordable Care Act market conduct examination identified no violations in most areas reviewed and imposed the lowest penalty reported to date of any insurer undergoing such an examination.”
The insurance department further ordered Capital to make internal changes to prevent such violations from happening again. Humphreys further said, “Capital Blue Cross has been cooperative in its response to the exam, and we expect we will see continued improvement when re-examinations occur.”Capital continually evaluates its operations and procedures to ensure it is meeting the needs of our members, and we appreciate the department’s thorough and thoughtful review of our efforts. Capital already has taken action to address the issues noted in this exam, which covered a 15-month period in 2017 and 2018.
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