Consumers to receive refunds as UnitedHealthcare pays $1M penalty for birth control coverage violations in NY

ROCHESTER, N.Y. — New York Attorney General Letitia James secured $1 million from UnitedHealthcare of New York, Inc., the country’s largest health insurer, for failing to provide coverage of birth control through its health plans.

The Office of the Attorney General (OAG) received a complaint from a patient in Brooklyn who was denied coverage for their oral contraceptive by UnitedHealthcare’s Oxford health plan, in violation of New York’s Comprehensive Contraceptive Coverage Act (CCCA). The CCCA requires health insurance plans to cover FDA-approved contraceptives without copays, restrictions, or delays.

In addition to paying a $1 million penalty, UnitedHealthcare will refund consumers who were denied coverage by any of its health plans and were forced to pay out-of-pocket costs to purchase their prescribed birth control. Eligible consumers will receive payment in the mail and those with potential claims will be notified and asked to submit a claim.

Consumers covered by UnitedHealthcare who paid for contraception and believe they should have been covered in full may submit a claim by emailing UHC_NYContraceptives_support@uhc.com. UnitedHealthcare must also ensure that all its health plans cover birth control without restrictions or delays as required by the CCCA.

The OAG’s Health Care Bureau opened an investigation into UnitedHealthcare after receiving a complaint from a patient that their prescription oral contraceptive was denied coverage by UnitedHealthcare’s Oxford plan. The patient’s appeal was rejected, and the health plan required the patient to obtain prior authorization or step therapy, a process requiring patients to try alternative treatments. UnitedHealthcare’s denial of coverage and further delays forced the patient to go without birth control and violated New York’s CCCA.

Health insurers that deny, restrict, or delay coverage of birth control impose unnecessary and unwarranted costs for patients, restrict equitable access to reproductive care, and force patients to skip or delay care because of financial barriers. Under New York’s CCCA, health insurance plans are required to cover FDA-approved contraceptives without copays and to remove any actions that might limit or delay access to care, including prior authorizations, step therapy, and exception processes.

As a result of this settlement, UnitedHealthcare will pay a $1 million penalty and ensure that all of its health plans are covering contraception without copays, restrictions, or delays as required by New York’s CCCA. Additionally, UnitedHealthcare will ensure all staff involved in the claim approvals process for contraception are trained in compliance with New York laws.

The settlement also requires UnitedHealthcare to reimburse all out-of-pocket costs paid by consumers for their birth control, plus 12 percent interest. Eligible consumers include patients who paid a copay for contraceptives that should have been covered without cost-sharing under CCCA from June 1, 2020, onwards.

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