ALBANY — EmblemHealth has reached a $250,000 settlement with the state of New York over charges the health insurance provider's denial of claims for gender reassignment surgery was unlawful.
According to the New York Attorney General's Office, an investigation found that EmblemHealth denied 22 out of 79 claims for gender reassignment surgeries and deceived its plan members by informing them that the coverage guidelines were "based on current clinical information and standard guidelines." EmblemHealth's criteria actually was unlawful and in violation of Executive Law and General Business Law, the Attorney General's Office said.
“Health plans have a basic obligation to cover medically necessary health care for their transgender members,” New York Attorney General Barbara Underwood said in a statement. “My office will continue to protect the rights of transgender New Yorkers and ensure they’re treated with the fairness and dignity they deserve.”
The settlement also includes EmblemHealth giving full restitution to those whose claims were denied and who had to pay out-of-pocket for gender reassignment surgical procedures, Underwood's office said.