By Haley Viccaro, Gannett
HealthNow was fined $700,000 by the state Department of Financial Services for not informing customers about coverage and benefits.
The Buffalo-based insurer failed to explain coverage, benefit rights and how to appeal claims denials to about 164,000 health-plan members.
"Consumers have a right to know what their health plans cover, what the plans don't cover, and what they can do when their claims have been denied," Superintendent of Financial Services Benjamin Lawsky said in a statement.
HealthNow did not provide explanation of benefits statements to customers and also didn't give members written acknowledgement of grievances within 15 business days; both are required under state law, Lawsky said.
The company didn't file certificates of appointments for agents and also failed to provide timely notices of appointment of agents, notify the department of termination of agents or ensure that commissions were paid by licensed producers, Lawsky said.
HealthNow said they will take steps to prevent the violations from occurring in the future by revising procedures in sending explanation of benefits statements to customers.
Here is a statement issued by HealthNow:
HealthNow New York cooperated with the Department of Financial Services (DFS) for a five year Market Conduct Report covering the time period of January 1, 2004 to December 31, 2008.
Throughout the thorough examination process, the company provided the DFS all of the requested documentation.
The issues identified, and imposed fine, relate largely to recordkeeping practices the company had in place during the outlined time period.
As result of the process, HealthNow developed and implemented a corrective action plan that addresses the findings of the Market Conduct Report, and we are taking the steps to ensure proper compliance with recordkeeping in the future. HealthNow has rendered the imposed fine to the State of New York.
As the region's leading health plan for 76 years, HealthNow remains focused on providing the best service, security and stability for our 800,000 members.
Julie R. Snyder
Director, corporate relations