ATTORNEY GENERAL JAMES SECURES REFUNDS FOR NEW YORKERS WRONGFULLY CHARGED FOR FREE COVID-19 TESTING AND HIV SCREENING SERVICES

The following information was released by the office of the New York Attorney General:

New York Attorney General Letitia James today announced a settlement with Fidelis Care (Fidelis), a New York-based health insurer, after an investigation by the Office of the Attorney General (OAG) found that the company wrongly required New Yorkers to pay for visits related to COVID-19 testing and for certain HIV screening services. As a result, some New Yorkers received bills for hundreds of dollars for services that, under state and federal law, should have been free. As part of the agreement, Fidelis has reprocessed tens of thousands of claims, paid more than $2.8 million to affected providers, ensured providers cancelled bills to consumers and refunded consumers for payments, fixed its internal systems to prevent future problems, and will pay a $175,000 penalty to the state.

"No New Yorker should ever face a surprise medical bill for care the law says must be free," said Attorney General James. "Fidelis' practices placed unnecessary financial stress on families who were simply trying to stay healthy during a public health crisis. My office will always stand up for New Yorkers when insurers fail to follow the law."

The OAG investigation found that Fidelis wrongfully required patients to pay out-of-pocket costs for health care services that were supposed to be provided for free. As a result of Fidelis' practices, between October 2021 and August 2022, providers charged patients for more than 38,000 office visits related to COVID-19 testing, affecting over 18,000 consumers. Between January 2022 and May 2023, providers charged patients for more than 2,800 HIV screening services, affecting more than 2,100 consumers. Both COVID-19 testing visits during the federal Public Health Emergency and HIV preventive screenings were required by law to be covered with no out-of-pocket cost to consumers.

As a result of the OAG investigation, Fidelis paid providers $2.6 million for COVID-19 testing visits and more than $157,000 for HIV screening services, including required interest. Fidelis also contacted every affected provider to make sure that improper patient bills were canceled and that consumers who paid out-of-pocket were refunded. The company sent corrected explanations of benefits to all impacted consumers and updated its internal systems to ensure these errors do not happen again.

Under today's agreement, Fidelis is prohibited from charging patients for these HIV screening services and must stop attempts to collect on charges for services provided during the COVID-19 Public Health Emergency. If Fidelis finds any additional claims that were wrongly processed, it must fix those claims, notify the affected consumers, direct providers to cancel any inappropriate bills, ensure refunds are issued, and update its systems as needed. Fidelis must also cooperate with OAG on consumer complaints and provide documentation showing it is following the agreement. In addition to a $175,000 penalty, Fidelis may be fined up to $500 for each future violation.

If a patient believes they have been a victim of misleading billing practices, they should contact OAG's Health Care Bureau onlineor call1-800-428-9071.

This matter was handled byAssistant Attorney Generals Eve Woodin and Brant Campbell of the Health Care Bureau under the supervision of Deputy Bureau Chief Leslieann Cachola and Bureau Chief Darsana Srinivasan. TheHealth CareBureau is part of the Division for Social Justice, led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.