New York insurer Oxford Health has been fined $665,000 because it failed to provide explanation of benefits (EOB) statements, meaning it didn't adequately inform its members about their health coverage or how to challenge denials of claims, the New York Department of Financial Services announced Thursday. The agency said there were about 300,000 instances in which Oxford didn't give members the EOB statements, which are required by state law.
"Insurers must provide their members with clear descriptions of their benefits each and every time a claim is processed. Consumers have every right to know what their health plans cover, what the plans don't cover, and what they can do when their claims have been denied improperly," said Superintendent of Financial Benjamin Lawsky. "This fine reflects the serious and systematic nature of the practices uncovered by the Department. At the same time, we are encouraged by Oxford's commitment to addressing the Department's findings and improving its performance going forward." Statement