Blue Cross Policyholders Challenge Overpayment Offsets

Dec. 27, 2018, 2:07 PM; Updated: Dec. 27, 2018, 7:08 PM

Blue Cross Blue Shield Minnesota is accused of improperly reducing policyholders’ benefit payments by amounts the insurer says it overpaid for unrelated medical expenses.

BCBSM allegedly violates federal benefits law through these reductions because no provisions in the BCBSM plan at issue expressly allows the company to offset future benefit payments by the overpayments, according to the lawsuit filed Dec. 27 in the U.S. District Court for the District of Minnesota.

The lawsuit, filed by a family insured by a BCBS plan, seeks class status for other insureds similarly affected.

BCBSM also allegedly makes it offset-related determinations without providing detailed information required by the Employee Retirement Income Security Act.

The insurer violates ERISA each time it offset benefits because it withholds benefits that policyholders are entitled to without complying with the law, the lawsuit says.

The policyholders seek to recover unpaid benefits in the amount withheld or offset by BCBS, interest, plus attorneys’ fees, costs and other appropriate relief, the lawsuit said.

BCBSM doesn’t comment on active litigation, a company spokesman told Bloomberg Law Dec. 27.

Lockridge Grindal Nauen PLLP and Jordan Lewis PA represent the insureds.

The case is L.P. v. BCBSM, Inc., D. Minn., No. 0:18-cv-03472-DWF-LIB, complaint filed 12/26/18.

(Updated to add company comment. )

To contact the reporter on this story: Carmen Castro-Pagan in Washington at ccastro-pagan@bloomberglaw.com

To contact the editors responsible for this story: Jo-el J. Meyer at jmeyer@bloomberglaw.com; Steven Patrick at spatrick@bloomberglaw.com

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