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21 Health Insurers and HMOs Fined for Failing To Process Claims On Time

Superintendent of Insurance Gregory V. 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% 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 today cover complaints closed from January 2003 through September 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
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
Total $212,300

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


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