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STATE POLITICS & POLICY | N.Y. Insurance Dept. Fines HealthNow for Denying Claims From Women Seeking Infertility Treatment

STATE POLITICS & POLICY | N.Y. Insurance Dept. Fines HealthNow for Denying Claims From Women Seeking Infertility Treatment
[July 23, 2008]

The health insurance group HealthNow New York will be forced to pay more than $1 million for improperly denying claims from women who were infertile and seeking treatment and failing to give enough notice of rate increases, the Buffalo News reports (Epstein, Buffalo News, 7/21). The New York State Insurance Department announced that it had fined the company for denying the claim of an Ithaca, N.Y., woman and announced that the company must reprocess 2,500 similar claims from other women, the Rochester Democrat and Chronicle reports.

According to state officials, state law requires that group insurance policies cover infertility treatment, with the exception of certain procedures such as in vitro fertilization. Eric Dinallo, superintendent of the state insurance department, said that insurance companies also are not permitted to create blanket exclusions (Stinson, Rochester Democrat and Chronicle, 7/22).

HealthNow -- which is the parent company of Blue Cross Blue Shield of Western New York and BCBS of northeastern New York -- must pay $600,000 in penalties for denying claims from women seeking infertility treatment. The company also must pay $450,000 for other insurance law violations, including giving only 15 days' notice of a rate increase instead of the 30 days required by state law. HealthNow also was penalized for not paying claims within 45 days of receipt, failing to deny or request information from members within 30 days of receipt of a claim and inconsistent financial reporting (Buffalo News, 7/21).