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