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Cyrus Dugger

N.Y. Fines 21 Health Plans For Prompt Pay Violations

The challenges in receiving prompt payment of legitimate insurance claims has been discussed in my previous posts:

The Check is Not in the Mail: Watching Your Medical Costs Go Up (medical insurance)
The Option of Indefinite Denial: NYS Legis. Considers Auto Insurance Nightmare (auto insurance)
NY Auto Insurance Nightmare Continues: The Option of Indefinite Denial & Access to Your Med. Insurance (auto insurance)

And in many posts by nyceve including:

Blue Cross Watch: California Hospitals Being Routinely Defrauded

Although it is encouraging that these instances have been brought to the attention of the New York State Insurance Department and that they have subsequently levied these fines, countless other cases of these types of violations go unreported and at times unidentified by consumers. (read the comments section of Blue Cross Watch: California Hospitals Being Routinely Defrauded for an example). Moreover, the small amount of most of these fines makes it unlikely that they will serve as a real deterrent to these large insurance companies

The New York State Insurance Department has levied fines totaling $310,300 against 21 health insurers and health maintenance organizations (HMOs) for violations of New York's Prompt Pay Law. The violations and subsequent fines stemmed from complaint files that were closed by the department between Oct.1, 2005 and March 31, 2006, according to Superintendent of Insurance Howard Mills. New York's Prompt Pay Law requires health insurers and HMOs to pay undisputed health insurance claims within 45 days of receipt, ensuring timely payment. Since1997, the department says it has levied nearly $6.8 million in fines against health insurers and HMOs for violations. According to Mills, by agreeing to pay the fines, the companies are acknowledging that they failed to pay certain claims within the state-mandated timeframe. Health insurers and HMOs are also required to pay interest on undisputed claims in which payments were delayed. "New York's Prompt Pay Law has been extremely effective in ensuring that consumers and healthcare providers are paid in a timely fashion and remains an excellent deterrent against entities slow to pay undisputed claims," Mills stated. The fines, by company, are: Aetna $8,400.00 Affinity $5,000.00 Americhoice $30,100.00 Careplus $1,900.00 Centercare $3,400.00 CIGNA $2,100.00 Empire $5,000.00 Excellus $3,200.00 Fidelis $1,200.00 GHI HMO Select $2,300.00 Group Health, Inc. $13,800.00 Guardian $1,400.00 Health Plus $65,300.00 HealthNet $58,800.00 HealthNow (includes Community Blue) $3,100.00 HIP $7,400.00 Horizon $1,800.00 MDNY $22,900.00 Oxford $19,100.00 United Healthcare $16,300.00 Vytra $37,800.00 Source: New York State Insurance Department's

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Posted at 1:09 PM, Nov 13, 2006 in Insurance Industry
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