New York State
Insurance Department

ISSUED 1/29/2004


Prompt Pay Violations Decrease By Over 30% Since 1998 Seen As Good News For Consumers

        Superintendent of Insurance Gregory V. Serio today announced that the Department has finalized another round of fines against health insurers and HMOs for violating the state’s Prompt Pay Law. The 30 insurers and HMOs have been fined a total of $418,120 for failing to pay their claims on time. More notably is that prompt pay complaints are at a record low of 13,577 for 2003. This is a decrease of 31% from over 19,500 complaints in 1998.

        "The Department’s priority is to ensure that New York health insurance consumers are paid promptly. Since the Law was enacted, the Department has seen a marked decrease in the number of prompt pay complaints, indicating that this Law is having a positive impact and health insurers are making it a priority to pay consumers and providers in a timely manner," said Serio. "The Department remains committed to ensuring that health insurers comply with the Law and meet their obligation to pay undisputed claims timely or they will continue to be fined for failure to do so."

        The Prompt Pay Law, which went into effect in January 1998, requires all health insurers to pay undisputed health insurance claims within 45 days of receipt – ensuring the timely payment of claims. HMOs and health insurers have been fined a total of $5,397,520 since the Law went into effect.

        The round of fines cover prompt pay complaints closed from January 2001 through December 2002. The fines by company are as follows:

Company Fine   
Aetna Health, Inc.
Affinity Health Plan, Inc
Americhoice of New York, Inc.
Anthem Life & Health
CarePlus, LLC
Capital District Phys. Health Plan, Inc.
CenterCare, Inc.
CIGNA Healthcare of New York, Inc.
Connecticut General Life Insurance Co.
Community Choice Health Plan
Empire Healthchoice HMO, Inc.
Excellus Health Plan, Inc.
Fidelis Care New York
Group Health, Inc.
GHI HMO Select
Guardian Life Insurance Co.
Healthfirst PHSP, Inc.
HealthNow NY, Inc.
Horizon Healthcare
Independent Health Assoc.
MDNY Healthcare, Inc.
MVP Health Plan
Oriska Insurance Co.
United Healthcare
Unicare Life & Health Ins. Co.
Vytra Health Plans Long Island, Inc.
Wellcare of New York, Inc.
Hudson HealthPlan (formerly Westchester Prepaid Hlth Svc)
$ 9,900
$ 3,600
$ 500
$ 19,845
$ 200
$ 2,200
$ 17,400
$ 16,700
$ 6,900
$ 400
$ 6,400
$ 3,800
$ 21,400
$ 400
$ 1,900
$ 8,200
$ 30,100
$ 10,000
$ 53,500
$ 2,200
$ 1,675
$ 18,700
$ 200
$ 3,900
$ 28,000
$ 36,600
$ 400
$ 900
$ 4,400
$ 3,500


TOTAL $418,120

*includes additional fines for failure to provide a substantive response in a timely manner

        Consumers and providers with prompt payment complaints can call the Department’s toll-free hotline at 1-800-358-9260.