Health insurance woes are taking a toll on New Yorkers, but thanks to the state's Attorney General Letitia James, some relief is at hand. Yesterday, an announcement came from the office of the Attorney General Letitia James detailing a settlement they've brokered with Fidelis Care—a health insurer based in New York. After the Office of the Attorney General (OAG) conducted an investigation, it discovered that Fidelis had been charging patients for supposedly free COVID-19 and certain HIV screening services.
This isn't just a clerical error we're talking about; these charges were hitting New Yorkers for services that were legally required to be of no cost, according to both state and federal guidelines. The investigation revealed between October 2021 and August 2022, over 18,000 consumers were affected, getting billed for upwards of 38,000 office visits surrounding COVID-19 testing as reported by the Attorney General's Office. On top of that, from January 2022 to May 2023, more than 2,100 consumers got charged for over 2,800 HIV screening services—a clear violation of the free service laws in place.
In a statement obtained by the OAG, Attorney General James said, "No New Yorker should ever face a surprise medical bill for care the law says must be free." The settlement sees Fidelis paying back more than $2.8 million to the providers—they were also tasked with ensuring providers canceled the consumer bills and refunded whatever out-of-pocket expenses were made. They weren't just sent back to the drawing board; the settlement requires Fidelis to update their internal systems to prevent any future unlawful charges.
Over 18,000 New Yorkers will also be receiving refunds for medical bills, they should never have gotten in the first place, according to the settlement terms. Fidelis is on the hook for a $175,000 penalty to the state, and they'll be facing up to $500 in fines for any future violations, as they must now refrain from charging for these HIV screening services. The healthcare provider also needs to fix any claims they find were wrongfully processed, as well as to notify the consumers impacted, cancel any inappropriate bills, issue refunds, and—last but not least—ensure their systems are up to snuff.
It's worth noting, if you think you've been subjected to false billing practices, the OAG's Health Care Bureau is there to hear your grievance. They can be reached online or through a call at 1-800-428-9071. The settlement was a team effort, with Assistant Attorney Generals Eve Woodin and Brant Campbell of the Health Care Bureau at the wheel under the oversight of both Deputy Bureau Chief Leslieann Cachola and Bureau Chief Darsana Srinivasan.
