NEW YORK – New York Attorney General Letitia James announced a settlement with Fidelis Care, a New York-based health insurer, after an investigation by her office found that Fidelis had wrongly charged New Yorkers for visits related to COVID-19 and HIV screening services that, under state and federal law, should have been free. As part of the settlement, Fidelis has reprocessed tens of thousands of claims, paid over $2.8 million to providers affected by their actions, and ensured that providers cancelled bills and refunded payments to clients, as Fidelis required, for services that should have been provided for free. Additionally, Fidelis is required to fix its internal systems to prevent this from happening again and will pay a $175,000 fine to the state, as well as being fined up to $500 for each future violation.
“No New Yorker should ever face a surprise medical bill for care the law says must be free,” said Attorney General James. “Fidelis’ practices placed unnecessary financial stress on families who were simply trying to stay healthy during a public health crisis.”
Because of these practices, healthcare providers billed over 18,000 patients for more than 38,000 office visits related to COVID-19 between October 2021 and August 2022. Between January 2022 and May 2023, providers charged more than 2,100 patients for nearly 3,000 HIV screening services. Fidelis sent corrected explanations of benefits to all consumers impacted.
As a result of the settlement, Fidelis is prohibited from charging patients for HIV screening services and must cease all attempts to collect on charges for services provided during the COVID-19 public health emergency, which officially ended May 11, 2023, per the US Department of Health and Human Services. If Fidelis finds additional claims that were wrongfully processed, it is required to fix those claims, notify the clients impacted, direct health care providers to cancel these bills, ensure the payments are refunded, and update its systems as needed. They are also required to cooperate with the Office of the Attorney General on consumer complaints and provide the proper documentation to show that they are following the process outlined in the settlement.
If a patient believes they have been a victim of misleading billing practices, they should contact the Office of the Attorney General’s Health Care Bureau online or call 1-800-428-9071.
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