Excellus BlueCross BlueShield, the parent company of Univera Healthcare, has been fined $1 million for wrongly denying contraceptive coverage as a result of "internal system and process errors" and failing to resolve consumer grievances in a timely fashion, according to the state Department of Financial Services.
New York law requires health plans to provide coverage for all contraceptive drugs and devices, and plans that came into existence after the Affordable Care Act must cover at least one form of contraception in each FDA-approved contraceptive method without co-pays, coinsurance or deductibles.
The department earlier this year announced it would conduct an investigation after it completed an "undercover sting" that found some insurers didn't provide accurate information about all contraception options and costs.
"DFS is taking this action to ensure that women receive the reproductive health care benefits they are entitled to under New York law,” Financial Services Superintendent Maria T. Vullo said in a statement.
An examination by the department found that between 2008 and 2013 Excellus erroneously denied 1,000 claims for contraceptive coverage due to an error in coding. The investigation also found that Excellus did not make prompt payment of certain claims and failed to deny some claims on a timely basis. Rochester-based Excellus also failed to acknowledge grievances by 482 insured members within 15 business days, and failed to resolve 339 grievances within the 30-day period mandated by law.
Excellus agreed to correct all violations. Accurate communication of contraception coverage has taken on greater importance since the Affordable Care Act mandates in 2010.
"The key findings in the report relate to items from a few years ago. Those issues were addressed when we completed a major transformation project, which consolidated several computer platforms down to one. The changes we made have brought about significant improvements to our claims payment system," said Peter Kates, spokesman for Univera.
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