New York Fines Excellus $1M Over Birth Control Claim Denials

Excellus says computer problems led to claim processing errors

(Photo: Thinkstock) (Photo: Thinkstock)

New York regulators have fined Excellus BlueCross BlueShield Health Plan $1 million for improperly denying state-mandated contraceptive coverage to some consumers between January 2008 and June 2014.

The New York State Department of Financial Services said about 1,000 people covered by the Rochester-based nonprofit health insurer did not receive coverage for contraception, as state laws require for most group policies in the state.

In a stipulation and consent order, Excellus acknowledged denying some claims due to coding errors, and admitted violations of state insurance laws for either not paying claims within prescribed deadlines, or failing to process in a timely way the grievances that resulted over nonpayment of benefits.

Related: N.Y.’s Schneiderman proposes free birth control access law)

In the order, Excellus agreed to correct any outstanding deficiencies and to file a report by Aug. 22 with DFS on corrective actions.

The order also gave Excellus seven days to pay the civil penalty to the state.

The department said it discovered the errors with Excellus as part of a wider review of insurance companies' compliance with state mandates that policies provide coverage for contraceptives and other reproductive health services.

In the wake of the announcement this week of the settlement with Excellus, Gov. Andrew Cuomo issued a statement in which he said the DFS's fine sends a "clear message that all insurance companies who attempt to deny or inhibit access to women's health care will be held accountable."

"Women deserve control over their health and reproductive decisions, and as Washington threatens to violate that right, it is more important than ever that New York—and states across the nation—stand up and demand women's right to access safe, affordable health care," Cuomo said in a statement.

Cuomo and state Attorney General Eric Schneiderman, both Democrats, have repeatedly said since Republican Donald Trump was elected president last November that the state would oppose any attempts to roll back contraceptive coverage by insurers or to limit access to abortion in New York.

James Redmond, vice president for communications at Excellus BlueCross BlueShield, said "significant improvements" have been made to Excellus' claims payment system since the period covered by the consent order.

"The key findings in the report relate to items from a few years ago," Redmond said Wednesday. "Those issues were addressed when we completed a major transformation project, which consolidated several computer platforms down to one."

In an area of oversight related to the contraceptive coverage, the financial services department issued a circular letter to insurers Wednesday reminding them that New York also requires infertility treatment coverage in most group policies and prohibits nonpayment based on the sexual orientation, marital status or gender identity of consumers.

The letter further said the state had adopted the same definitions for what constitutes infertility for insurance coverage purposes as those developed by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.

--- Read Obama Administration Turns Contraceptive Fight Over to Trump on ThinkAdvisor.

Originally published on New York Law Journal. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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