Group Health, a unit of Emblem Health, used improper billing and claims practices to overcharge its members for seeing out-of-network providers, New York Attorney General Eric Schneiderman said Tuesday. The state attorney general's office said that despite Group Health's policy to cover certain out-of-network doctors, including anesthesiologists, pathologists and radiologists, the insurer processed claims at its standard out-of-network rate, charging members for thousands of dollars of services that should have been covered. Under an agreement reached with Schneiderman, Group Health will refund patients up to $500,000 for three years of the improper billing practice. Group Health also will train its employees, pay a penalty and help consumers resolve any debt collection activity related to their insurance charges.
"Plans and providers must take care to abide by the terms of their policies and contracts and not exacerbate the already significant financial burdens consumers face in getting the healthcare they need," Schneiderman said. "At a time when legitimate medical bills are already an extraordinary burden on New Yorkers, improper billing and claims practices are even more deplorable." Statement