New York State insurance regulators say they have imposed a $1 million fine on a health insurer in connection with claims denied several years ago.
HealthNow New York Inc., Buffalo, N.Y., agreed to pay the fine, and to reprocess claim denials for about 2,500 women, to resolve an investigation by the New York department, officials say.
The New York department began the investigation after receiving a complaint that the carrier had denied a woman’s claim for coverage for fertility treatment in 2004.
The New York department found that the carrier had to pay the claim because the treatment was not specifically excluded under state law, and it then conducted a broader examination of the insurer, officials say.
Penalties include $600,000 for infertility coverage claim violations and $450,000 for other violations, such as giving members 15 days notice of rate increases, instead of the 30-day notice required by law, officials say.