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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. $104,300
Affinity Health Plan, Inc $9,900
Americhoice of New York, Inc. $3,600 *
Anthem Life & Health $500
CarePlus, LLC $19,845
Capital District Phys. Health Plan, Inc. $200
CenterCare, Inc. $2,200
CIGNA Healthcare of New York, Inc. $17,400
Connecticut General Life Insurance Co. $16,700
Community Choice Health Plan $6,900
Empire Healthchoice HMO, Inc. $400
Excellus Health Plan, Inc. $6,400
Fidelis Care New York $3,800
Group Health, Inc. $21,400
GHI HMO Select $400
Guardian Life Insurance Co. $1,900
Healthfirst PHSP, Inc. $8,200
HealthNet $30,100
HealthNow NY, Inc. $10,000
HIP $53,500
Horizon Healthcare $2,200
Independent Health Assoc. $1,675
MDNY Healthcare, Inc. $18,700
MVP Health Plan $200
Oriska Insurance Co. $3,900
Oxford $28,000
United Healthcare $36,600 *
Unicare Life & Health Ins. Co. $400 *
Vytra Health Plans Long Island, Inc. $900
Wellcare of New York, Inc. $4,400
Hudson HealthPlan (formerly Westchester Prepaid Hlth Svc) $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.

Department of Financial Services


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