Shaun Zinck Mar. 19, 2015, 11:26am


An upstate New York health insurer could pay out $9 million as part of a settlement for allegedly denying some patients coverage for rehabilitation and eating disorders, New York Attorney General Eric Schneiderman said Wednesday.

Schneiderman said Rochester-based Excellus Health Plan is required to cover residential treatment for behavioral health conditions and evaluate and reform procedures for behavioral health treatment claims.

Approximately 3,300 Excellus members, whose requests for eating disorder residential treatment and inpatient substance use rehabilitation were denied by the health insurer, will have the right to a new appeal for those claims. Schneiderman said Excellus wrongfully denied the patient requests between 2011 and 2014.

“Mental health and addiction recovery treatments must be regarded the same as other health insurance claims under the law,” Schneiderman said. “We will continue to take on those who ignore the law and reinforce the false and painful stigma often associated with these ailments.”

Excellus is a part of the Blue Cross Blue Shield Association and has approximately 1.5 million members in its network. The health insurer is the largest upstate New York health plan. The investigation conducted by Schneiderman's office found Excellus denied inpatient substance use disorder rehabilitation services about seven times more often than inpatient medical services.

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