10.132.115.101

Subscribe to our mailing list

What Topic Matters Most To You?
View Privacy Policy

New York Health Insurer Fined $1 Million Over Consumer Complaints

In nearly one-third of cases, Oxford Health Insurance failed to acknowledge consumer complaints within a lawful timeframe…

Earlier this month, New York regulators fined Oxford Health Insurance, a subsidiary of UnitedHealth with a history of paying fines, $1 million for improper payments to an unlicensed producer and for failing to respond to consumer grievances within the timeframes required by law.

Regulators found that in nearly one-third of cases, Oxford failed to acknowledge consumer complaints within a lawful timeframe:

“DFS’s market conduct examination found that in almost one-third of the cases sampled, the company failed to acknowledge consumer grievances within the required 15-day time frame; it also did not resolve grievance cases regarding referrals or benefit coverage within 30 days; and, in 44% of additional cases sampled, the company failed to issue initial adverse determination letters or adverse determination letters following an appeal within the 30 days mandated by law.”

Oxford Health has a history of paying hefty fines for violations of state law related to the way it treats its customers. In 2012, New York State fined Oxford Health $665,000 for failing to tell members why insurance claims were denied. In 2005, New York fined Oxford over $25,000 for failing to pay disputed claims. In 1997, Oxford was fined $3 million by the New York State Insurance Department for a “variety of legal violations.”

Last year, the New York State Attorney General fined Oxford Health’s parent company over anti-competitive practices involving elder care products.