Attorney General Paxton Investigates Blue Cross Blue Shield Insurance Company Over Denials and Delays of Urgent and Medically Necessary Care

Attorney General Ken Paxton launched an investigation into Blue Cross Blue Shield of Texas ("BCBSTX"), its parent company, Health Care Service Corporation ("HCSC"), and their related business entities. This investigation is based on BCBSTX's procedures for denying and delaying urgent and medically necessary care and its potentially burdensome prior authorization requirements.

Reports received by the OAG indicate that BCBSTX may have denied or delayed coverage for procedures deemed medically necessary or urgent. One case reported to the OAG involved a newborn baby in need of urgent medical treatment. Although the procedure was allegedly covered under the applicable health plan, administrative denials and potentially improper utilization review procedures delayed approval of a transfer to a facility capable of providing the care the newborn needed.

In many cases, BCBSTX allegedly delayed granting approval for medically urgent treatment. These delays may have postponed medically necessary treatment and potentially caused consumer harm. Such delays can worsen a patient's condition, increase the risk of complications, allow disease progression, cause disability or death, and increase administrative costs.

"Blue Cross Blue Shield has a responsibility to put patients before profits and ensure that Texans receive the care they need," said Attorney General Paxton. "When a newborn baby or any other Texan urgently needs medical treatment, an insurance company's priority should be helping provide that care to the best of its ability-not searching for ways to delay or deny it. I will wage a relentless legal battle against any insurance company that fails to protect health and safety of Texans."

The investigation will focus on representations made by BCBSTX regarding its approval and denial of medically necessary claims. Attorney General Paxton will determine whether claims are denied without adequate review or whether the company engages in any other unlawful practices. As part of the investigation, Attorney General Paxton has issued a Civil Investigative Demand ("CID") to obtain information and determine whether BCBSTX, HCSC, or related entities violated Texas law, including the Texas Deceptive Trade Practices Act ("DTPA").