HealthNow to pay fine, policyholder’s claims in settlement
The office of the state attorney general in New York reached a settlement with BlueShield and two sister organizations. In addition, there is also a requirement for the insurance company to review and revise its current practices.
HealthNow, BlueShield’s parent company, issued a statement saying that it would make the changes needed to ensure the company was in compliance with the law and with the settlement.
The attorney general’s office said that BlueShield of Northwestern New York wrongfully denied $1.6 million in claims for nutritional counseling and psychotherapy. This broke both federal and state laws when the mental health services claims were denied. The attorney general said, “Individuals confronting mental health conditions, eating disorders, or substance abuse should not be denied coverage for the treatment they need and deserve.”
Last year, the attorney general’s office started an investigation after it began receiving complaints from BlueShield’s policyholders about mental health visits requiring preauthorizations. This is because the policy states that mental health services do not require preauthorization until after the 20th visit each year.
Those who suffer from bulimia, anorexia and other disorders associated with eating were also denied coverage, even though diabetes counseling was covered.
This is the sixth time since 2014 that the attorney general’s office has signed settlements with insurance companies after it was determined that they didn’t comply with federal and/or state laws.
If you have a wrongfully denied claim for covered medical care, you do have options. An experienced lawyer can help you seek the benefits you deserve. This may be through an appeal or through a lawsuit.
Source: timesunion.com, “AG: BlueShield illegally denied claims for mental, nutritional counseling,” Claire Hughes, Aug. 21, 2016