EmblemHealth settles with New York over denied medical claims

NEW YORK (Legal Newsline) - New York Attorney General Eric Schneiderman announced a settlement on Wednesday with a health insurance company to resolve allegations that it failed to offer continuation coverage for young adults and wrongfully denied medical claims.

EmblemHealth Inc., a company that provides coverage to 3.4 million New Yorkers through its Health Insurance Plan of Greater New York and Group Health Incorporated units, allegedly wrongfully terminated the coverage of young adults and denied medical treatment claims. New York's Age 29 Law requires health insurers to offer continuation health coverage to children of plan members until they turn 30 years old.

"The people of New York recognize that young adults need affordable, quality health coverage-and that includes having the option to stay on their parents' insurance through their 20s," Schneiderman said. "This settlement sends a message to insurance companies that want to do business in New York: Providing health coverage to New Yorkers also means playing by the rules and following the laws of our state, which are often stronger than federal regulations."

Emblem allegedly failed to send statutorily required letters to more than 8,000 Emblem members between 2010 and 2012, including almost 1,000 individuals who had their coverage terminated. Emblem also allegedly denied approximately 175 claims from 105 members who did not receive proper notification under the Age 29 Law.

Under the terms of the settlement, Emblem will offer reinstatement of health coverage to more than 8,000 young adults, pay approximately $90,000 in denied claims, pay $100,000 to Schneiderman's office as a civil penalty and submit to monitoring and an independent audit.