The New York State Department of Financial Services fined Excellus Health Plan $1 million for wrongfully denying coverage for contraceptive services.
New York state law requires health plans to cover all contraceptive drugs and devices. For non-grandfathered health plans, the requirement is coverage of at least one type of contraception in each of the Food and Drug Administration-approved contraceptive delivery methods free of co-pays, coinsurance or deductibles.
A DFS investigation uncovered Excellus incorrectly denied 1,000 claims for contraceptive care because of a coding error. The department also found the payer failed to promptly pay or deny claims of contraceptive coverage and address hundreds of consumers' concern within legally required time frames.
Excellus agreed to "take all steps necessary to correct all violations and to comply with New York state insurance law and regulations in the future," Financial Services Superintendent Maria Vullo said.