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Insurance Co. Pays for Illegal Policy Changes

Affected Health Care Reimbursements

Attorney General Eric T. Schneiderman announced a settlement with AXA Equitable Life Insurance Company after an investigation revealed that the corporation made an undisclosed change to its medical claim reimbursement policy resulting in lower reimbursements for many members.

As a result of the investigation, AXA Equitable has already changed its medical claim reimbursement policy to honor the terms of its members’ health insurance plans. The settlement, which could reach $850,000, requires AXA Equitable to pay restitution to members, in New York as well as outside the state, who were adversely impacted by the insurance company’s actions.

“These consumers paid their bills and played by the rules, only to discover their insurance policies had changed with no warning by AXA Equitable. At the very least-consumers should expect that the terms of their health plans are honored,” said Schneiderman. “It is unacceptable for AXA Equitable to switch its claim reimbursement policy to one that pays less, without alerting plan members.”

The Attorney General’s Health Care Bureau found that beginning in September 2011 and continuing through May, despite the policy’s terms of reimbursement at the usual and customary rate, AXA Equitable used data from a third-party to reimburse medical claims affecting several hundred consumers. The switch resulted in lower medical claim reimbursements for many members than had been the case previously.

AXA Equitable has agreed to reimburse consumers in an amount that could reach almost $850,000. Within 60 days of the signed agreement, AXA Equitable will mail members information on how they can submit a claim for restitution. AXA Equitable also agreed to:

– Employ FAIR Health, Inc. www.fairhealth.org as the data source for its medical claims reimbursement policy. FAIR Health, Inc. was established in October 2009 as part of the settlement of an investigation by the New York State Attorney General, into the health insurance industry’s methods for determining out-ofnetwork reimbursement.

– Prepare and file a report with the Office of the Attorney General that contains pertinent information regarding the member restitution process including the number of notices sent to members, the number of

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