IBJNews

New York orders WellPoint to make refunds for overcharges

Back to TopCommentsE-mailPrint

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.”


ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by
ADVERTISEMENT

facebook - twitter on Facebook & Twitter

Follow on TwitterFollow IBJ on Facebook:
Follow on TwitterFollow IBJ's Tweets on these topics:
 
Subscribe to IBJ
  1. something to take iman's mind off CART,,,the league itsownself doesn't do it

  2. Someone mentioned a green roof. Every designer of a new urban building should be required to at least explore the feasibility of a green roof. The ability to cut carbon dioxide, save precious rainwater (drought this summer??) and re-use grey water, cool the building cheaper, and improve the view for neighbors, should be, not only the good neighbor thing to do, it should be the responsible neighbor thing to do. Too bad the city didn't require it when they gave up downtown green space for the Simon Building. Surprised they aren't requiring it now.

  3. About the same means down, like the TV ratings.

    My favorite tradition that needs to be brought back is the 25/8 rule.

  4. Your stats are incorrect. The 85k Government employees working in Marion County includes all government workers in Marion county. That is state, federal, non profit agencies, city and county. The stats the article list is the number of employees for all of the city/county employees and it is correct. That number includes the library, airport, convention center, and so on. The policy of extending benefits to domestic partners is consistent with private sector companies of the same size. Isn't the mantra of most conservatives "run the government like a business."

    Also, too say the "fiscal proposil is huge" without considering the actuarial factors involved is a bit of an overstatement. We really don't know if it is huge or not. If all of the people added to the plan are healthy and don't have claims then it could bring cost done or hold them neutral.

  5. There are 85,346 government employees in Marion county according to Stats Indiana.

    My understanding is that this proposal covers not only same sex partners and children, but opposite same sex partners who are not married and any kids.

    It also covers all city and county employees, plus municipal corporations which use city/county benefits packages including Health and Hospital Corporation (Wishard), Indianapolis Airport Authority, Indianapolis Convention Center,Lucas Oil,Bankers Life, Indianapolis Marion County Library, and Indianapolis Public Transportation Corporation (IndyGo).

    Certainly Indianapolis Public Schools will also want more benefits also.

    The fiscal cost on this proposal is huge.

ADVERTISEMENT