NY State Attorney General forces Blue Cross to change ID card

Long Island Business News, Dec 20, 2002 by Rosamaria Mancini

State Attorney General Eliot Spitzer has reached an agreement with two upstate divisions of HealthNow that will require the insurance providers to remove language from member identification cards that failed to properly inform consumers of their rights to obtain emergency care.

The divisions are Blue-Cross Blue-Shield of Western New York and Blue Shield of Northeastern New York.

"State law expressly mandates that health plans cover the cost of treating any emergency condition that meets the prudent layperson standard and bars health plans from requiring pre-authorization for such treatment," Spitzer said.

Spitzer's office began the investigation after hearing complaints from members about the misleading language found on member ID cards.

For example, HealthNow Flex ID cards instructed members to "contact your Primary Care Physician" in the case of an emergency, and only "if not possible" to first contact your PCP, "proceed to the nearest urgent care center or emergency room . . . ."

This type of language amounted to a pre-authorization requirement for emergency care, which is strictly prohibited under New York law, Spitzer said.

Other Blue Cross member ID cards contained language that instructed: "In a life-threatening emergency, go to the nearest emergency room . . . ."

State law requires health plans to cover emergency claims when the individual has symptoms that an ordinary person would believe pose a serious health risk, whether or not the ultimate diagnosis is "life- threatening."

Under the terms of the agreement, Blue Cross has issued new cards with revised language. It will also submit to the New York State Departments of Health and Insurance revised subscriber contracts to correct inaccurate language regarding emergency care found in those documents.

And it will review emergency claims it denied between April 1997 and June 2002 and reimburse any consumer who was denied emergency room claims that should have been covered.