NEW YORK (1010 WINS/WCBS 880) – UnitedHealthcare in New York has reached a settlement to pay $1 million for not providing birth control coverage in its health plans, the Office of the Attorney General announced on Thursday.
An investigation began after the OAG received a complaint from a Brooklyn patient. The patient was denied coverage for their oral contraceptive by UnitedHealthcare’s Oxford health plan, violating New York's Comprehensive Contraceptive Coverage Act.
The patient's appeal was rejected, and the health plan required them to get prior authorization or go through step therapy, which involves trying alternative treatments first, according to the OAG.
Due to these denials and delays, the patient was left without their birth control, violating the CCCA.
The CCCA requires health insurance plans to cover FDA-approved contraceptives without copays, restrictions, or delays. It also mandates that insurers must cover at least one version of each type of approved contraceptive if there are several equivalent options.
“Birth control is an important medication that millions of people use every day,” New York Attorney General Letitia James said in a statement. “Denying health insurance coverage of birth control can cause serious health concerns for anyone who takes the medication. Reproductive health care is essential to the safety and wellbeing of New Yorkers, and it is crucial that health insurers abide by New York’s reproductive health care laws.”
As a result of the settlement, aside from paying the $1 million penalty, UnitedHealthcare must reimburse all out-of-pocket costs paid by consumers for their birth control, plus 12 percent interest, according to AOG. This applies to patients who paid a copay for contraceptives that should have been covered without cost sharing under the CCCA from June 1, 2020, onwards.
"We apologize for the delay in access to one brand of progestin-only oral contraceptive in New York," Kristen Hellmer, a spokesperson for UnitedHealthcare, told 1010 WINS/WCBS 880 in response to the settlement. "We are in the process of resolving these claims with our members."
Eligible patients will receive payment in the mail and those with potential claims will be notified and asked to submit a claim.
Patients covered by UnitedHealthcare who paid for contraception and believe they should have been covered in full can submit a claim by emailing UHC_NYContraceptives_support@uhc.com.
Additionally, UnitedHealthcare will make sure that all staff involved in the claim approvals process for contraception are trained on compliance with New York laws.