New York State Attorney General (NYAG) Eric T. Schneiderman has struck settlements with insurance companies and providers resulting in refunds of $500,000 to patients and an agreement to stop alleged improper billing. Due to the AG’s investigation, Group Health Inc. (GHI) has already returned $162,000 to New York consumers, the AG’s office said.
The agreements are with GHI, part of EmblemHealth, and New York Medical & Diagnostic Center, Inc. (NYMDC), a twenty-provider group in New York City.
The NYAG’s office Health Care Bureau conducts investigations into health insurance companies and others, as does the state Department of Financial Services (DFS), the state insurance regulator.
The NYAG’s office encourages people who believe they may have been treated unfairly by a health care provider or health plan to call the AG’s Health Care Helpline.
The NYAG’s office has had a health care bureau and a hotline since 1997.
The cases were handled by the NYAG’s Health Care Bureau as well as the Executive Deputy Attorney General for Social Justice. The AG’s office can investigate and charge health insurers under a panoply of state statutes outside of insurance law.
DFS Superintendent Benjamin Lawsky, in his first year as head of the DFS, has made health insurance costs and coverage a cornerstone of his stewardship, using such measures as the state medical loss ratio requirements.
These particular NYAG cases arose after consumers turned to the Health Care Bureau for help. In both cases, the consumers followed the rules of their insurance coverage yet were hit with unexpected doctor bills, most of which should have been covered, the NYAG’s office stated.
“Unexpected medical bills are a devastating problem for New Yorkers. Insurance companies and health care providers must be held accountable for violating the law and overcharging patients,” Schneiderman stated.