N.Y. Dept. Levies More than $212,000 in Prompt Pay Violations on 21 Health Insurers, HMOs

April 29, 2004

New York Superintendent of Insurance Gregory Serio announced that the Department has levied $212,300 in fines against 21 health insurers and HMOs for failing to process their claims on time. The violations represent the eighth round of fines since the Prompt Pay Law went into effect in January 1998.

“The Prompt Pay Law was enacted to ensure that health insurance claims are paid in a timely manner,” Serio said. “During 2003, the Department received 13,577 prompt pay complaints, a 31 percent decrease from the complaints registered in 1998 an indication that this Law has been effective. The Department remains committed to the enforcement of this law to ensure health insurance consumers are protected.”

The Prompt Pay Law requires health insurers and HMOs to pay undisputed health insurance claims within 45 days of receipt – ensuring the timely payment of claims. Since the effective date of the law, this Department has levied more than $5.6 million against insurers and HMOs for prompt pay violations.

The fines levied this week cover complaints closed from January 2003 through Sept. 30, 2003. The fines by company are as follows:

Company/Fine – Aetna Health Inc. $11,500; Affinity Health Plan $1,000; Americhoice of New York Inc. $2,300; CarePlus LLC $3,800; CIGNA $12,900; Community Choice Health Plan $3,400; Excellus Health Plan $3,800; NYS Catholic Health Plan d/b/a Fidelis Cares New York $1,200; Group Health Inc. $24,200; GHI HMO Select Inc. $1,300; HealthFirst PHSP Inc. $4,100; HealthNet of New York $14,300; HealthNow New York $1,000; HIP $28,500; Horizon Healthcare $3,600; Hudson Health Plan $1,200; Independent Health Assoc. $400; MDNY Healthcare $9,600; Oxford Health Plans $66,000;
United Healthcare $14,800; Wellcare of New York $3,400.

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