DFS Fines Excellus Health Plan $1 Million for Illegally Denying Consumers Contraceptive Coverage and Other Violations of New York Insurance Law
Financial Services Superintendent
Under
"DFS is taking this action to ensure that women receive the reproductive healthcare benefits they are entitled to under
A market conduct examination by DFS found that between 2008 and 2013, Excellus erroneously denied 1,000 claims for contraceptive coverage due to an error in coding. DFS is currently investigating whether insurers are complying with
The DFS investigation also found that Excellus did not make prompt payment of certain healthcare claims, payment of interest on some claims and failed to deny some claims on a timely basis. Excellus also failed to acknowledge grievances by 482 insureds within 15 business days and failed to resolve 339 grievances within the 30-day period mandated by New York Insurance Law.
Under the consent order, Excellus has agreed to take all steps necessary to correct all violations and to comply with
A copy of the consent order between Excellus and DFS can be found here (http://www.dfs.ny.gov/about/ea/ea170417.pdf).
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