Despite the fact that the NYS Department of Financial Services issued an order waiving all copays and deductibles for tele-health visits, some insurance companies continue to ignore the ruling.  The order is explicit in stating that it is both for COVID-19 and non-COVID cases, as well as mental health, The ruling can be found at this url :

https://www.dfs.ny.gov/reports_and_publications/press_releases/pr20203171

Here is the relevant quote:  

“Superintendent of Financial Services Linda A. Lacewell said, “Today’s adopted regulation instructs insurance companies to provide telehealth services at zero cost for New York consumers.  This not only applies for COVID-19, it applies for any other covered health care services including mental health and substance use disorder treatment needed by the consumer, ensuring access to quality, affordable care right in their own home.”

In this column, I will publicly shame and call out by name, insurance companies who are playing dumb and ignoring this ruling.  As of Friday, 3/27/22, random calls were made to customer service representatives from Amerigroup, AETNA, and Oxford. The representatives said, “The only time copay will be waived is if a patient is going to get tested for COVID-19.”  Just to make sure, a supervisor was requested, who confirmed the same misinformation.

Dear readers, do not tolerate this abuse.  Here is the link to the NYS Department of Insurance so you can make an online complaint, which is easy to do:  https://www.dfs.ny.gov/complaint

Now, the insurance companies or going to claim, “It was chaos, we did not get a chance to train our workers.”  I ask, has anyone ever experienced an insurance company overpaying or over covering a service due to poorly trained workers?  And, in any case, it is in their self-serving interest to hire the most  poorly trained people so this way they have plausible deniability as they reap in profits. 

Even when insurance companies get caught in the act of violating coverage terms such as the the Parity Law Case and what happened to Emblem Health years ago, they still make out like bandits.  Here is why: Even when forced to pay back members for denied claims, plus interest, there is no way to possibly account for the majority of patients who simply didn’t even pursue a claim due to feeling discouraged.  If a sick and depressed person calls an insurance company to ask information about coverage and gets obfuscation or an actual illegal denial, assuming the poor fellow doesn’t commit suicide (which saves the insurance company lots of money), will he really obtain services anyway?  If he doesn’t actually take the services, it will not help later that the insurance company is forced to cover it retroactively.  And, if in general, it takes too many hoops and calls to get an appointment for so-called covered mental health services, then the person just gives up and avoids seeking treatment.  

Remember, insurance companies make money by selling a product that appears to cover as much as possible, and actually covers as little as possible, or at least delays paying as long as possible.  Do not be a victim and do not let them get away with it. Know your rights, know the law.

Translations Courtesy of Sefaria, except when, sometimes, I disagree with the translation

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