A New York payor and provider have each settled separate charges of improper billing practices, and each case involved patients allegedly receiving unexpected physicians bills that should have been covered.
Group Health is a major health insurance company with more than 1 million customers in New York. The policy was required to cover certain medical providers who might be out-of-network, such as anesthesiologists, pathologists and radiologists, with no member cost-share. Group Health allegedly processed claims at its standard rate, however, which resulted in patients receiving bills for physician services — sometimes worth thousands of dollars — when they should have been covered.
New York Medical & Diagnostic Center is a 20-provider multispecialty group. It allegedly billed patients the difference between the original charge and the payment by the patient's health plan. NYDMC was required to accept the plan's payment as payment in full, and the alleged "balance billing" practices are illegal in New York.
Group Health will reimburse those who were affected. It has already returned $162,000 to consumers, but that figure is expected to reach $500,000 in restitution for three years' worth of claims.
NYDMC will send refunds to affected patients — up to $500,000 — and ensure all collection activities cease and patients' credit scores are restored.
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Group Health is a major health insurance company with more than 1 million customers in New York. The policy was required to cover certain medical providers who might be out-of-network, such as anesthesiologists, pathologists and radiologists, with no member cost-share. Group Health allegedly processed claims at its standard rate, however, which resulted in patients receiving bills for physician services — sometimes worth thousands of dollars — when they should have been covered.
New York Medical & Diagnostic Center is a 20-provider multispecialty group. It allegedly billed patients the difference between the original charge and the payment by the patient's health plan. NYDMC was required to accept the plan's payment as payment in full, and the alleged "balance billing" practices are illegal in New York.
Group Health will reimburse those who were affected. It has already returned $162,000 to consumers, but that figure is expected to reach $500,000 in restitution for three years' worth of claims.
NYDMC will send refunds to affected patients — up to $500,000 — and ensure all collection activities cease and patients' credit scores are restored.
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