NEW YORK (Legal Newsline) — New York Attorney Genera Eric T. Schneiderman has announced that HealthNow, New York Inc. will pay many of its members after allegations of wrongfully denying thousands of claims for outpatient psychotherapy and more than 100 claims for nutritional counseling for eating disorders. The alleged wrongful denials totaled more than $1.6 million in patient claims.
The Buffalo-based company provides health care coverage for about 573,700 New Yorkers. According to Schneiderman’s office, the company allegedly improperly denied coverage for behavioral treatments by mandating that all outpatient behavioral health visits be pre-authorized after the first 20 visits per year. The company purportedly conducted thousands of wrongful reviews under its 20-visit threshold.
The company does not impose these same utilization reviews for outpatient medical services, the state said. Additionally, the company allegedly excluded coverage for nutritional counseling for eating disorders.
“Insurers have a legal obligation to provide the same level of care to patients being treated for behavioral health conditions as they do for patients with other ailments,” Schneiderman said. “Individuals confronting mental health conditions, eating disorders or substance abuse should not be denied coverage for the treatment they need and deserve.”
HealthNow will also pay a $60,000 fine to Schneiderman’s office.