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Excellus fined $1M for multiple insurance violations

Excellus

The state Department of Financial Services has slapped Excellus Health Plans with a $1 million fine for multiple violations of New York insurance law.

For one, Excellus incorrectly denied 1,000 claims for contraceptive coverage, according to DFS, due to “internal system and process errors.” DFS also found that Excellus failed to pay or deny claims promptly and acknowledge consumer grievances within required time frames.  

A spokesperson for Excellus said that the violations were from several years ago, before the company consolidated its computer systems and that the consolidation has improved its claim system.

Under New York insurance law, contraceptive coverage must be provided with no co-payments, deductibles or any out of pocket costs. The Excellus fine comes after DFS investigated 15 insurance companies undercover to check how accurately consumers were being informed about coverage. DFS found that 11 out of the 15 companies offered inaccurate information about contraceptive coverage or declined to provide any information.

Gov. Andrew Cuomo released a statement regarding the investigation.

"The steps taken today by the Department of Financial Services make good on our promise to women across the state and send a clear message that all insurance companies who attempt to deny or inhibit access to women’s health care will be held accountable,” he said.

The DFS is reviewing records of other health insurance companies to check for similar coding errors, according to a spokesperson.

The Rochester-based Excellus is part of a $6.6 billion family of companies that finances and delivers health care services across Upstate New York and long-term care insurance nationwide. According to the company, it collectively provides health insurance to nearly 1.5 million members and employs about 5,500 New Yorkers.