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New York orders WellPoint to make refunds for overcharges

November 10, 2011

Indianapolis-based WellPoint Inc. is among 11 insurers ordered to refund money to almost 600,000 New Yorkers who were charged too much for health insurance.

New York Governor Andrew M. Cuomo told the insurance companies they had to give back $114.5 million to policyholders because the carriers failed to spend the minimum 82 cents of each premium dollar on health care as required by the state, Cuomo said Wednesday in a statement. The mandate to spend a certain amount on medical care also is a federal requirement under the 2010 U.S. health overhaul law.

“In this economic climate, every penny counts and, in this case, insurance companies were overcharging New Yorkers to the tune of millions of dollars,” Cuomo said. “This should serve as a message to companies that we are watching, and we will not tolerate any action that wrongly hurts the finances of the people of New York.”

Refunds already are being sent to policyholders in the individual and small business market. The state has instructed insurers to make refunds on plans for larger employers by Dec. 15, according to the statement from Cuomo’s office.

WellPoint’s Empire BlueCross BlueShield was ordered to pay $61.1 million, the largest rebate demanded from insurers in New York. Excellus Health Plan Inc., a not-for-profit BlueCross BlueShield organization based in Rochester, New York, has been instructed to pay $21.4 million, the second-largest amount.

Other insurer refunds include $11.5 million for Connecticut-based Aetna; $5.1 million for Health Net of New York; and $4.8 million for Oxford Health Insurance Co., a unit of UnitedHealth Group Inc. of Minnesota.

New York changed its medical loss ratio, the formula that requires insurers to spend a certain portion of premium revenue on health care, in the middle of last year and applied it retroactively to January 2010, Cynthia Michener, an Aetna spokeswoman, said in an e-mail. This didn’t give the company the opportunity to price its plans “appropriately,” she said.

“The overwhelming majority of our New York business complied with the rules,” Michener said. Based on the previous requirements, “Aetna’s 2010 results would have met the standards.”

WellPoint’s Empire payments represent about 3 percent of its total premium revenue for insurance products subject to these laws, Kristin Binns, a WellPoint spokeswoman, said.

“As in previous years, and consistent with New York law, if the amount Empire pays for medical claims is unexpectedly low, Empire pays refunds to its customers,” Binns said. All Empire refunds were forwarded to affected customers as of Sept. 30, she said.

“Our spending on consumers’ health-care costs was within one-half of 1 percent of the state required level, illustrating the discipline we have in pricing our health plans to ensure premium rates closely track with expected claim costs,” said Daryl Richards, a spokesman for UnitedHealth. “In New York, the average company’s total annual rebate from UnitedHealthcare is about $120, evidence that costs closely matched premium collected.”

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