UnitedHealthcare to pay $1M for denying birth control coverage

June 24, 2024 Robert Abruzzese, Courthouse Editor

Attorney General Letitia James announced a $1 million settlement with UnitedHealthcare for failing to provide coverage of birth control, following a complaint from a Brooklyn patient. Photo: Brittainy Newman/AP

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UnitedHealthcare of New York Inc. has agreed to a $1 million settlement for failing to provide coverage for birth control as mandated by New York’s Comprehensive Contraceptive Coverage Act.

The penalty follows an investigation by the Office of the Attorney General prompted by a complaint from a Brooklyn patient whose oral contraceptive was denied coverage by UnitedHealthcare’s Oxford health plan.

The CCCA requires health insurance plans to cover FDA-approved contraceptives without copays, restrictions or delays. UnitedHealthcare’s denial of coverage violated this law, causing patients to pay out-of-pocket for their prescribed birth control. The insurer will now refund consumers who were denied coverage and forced to bear these costs.

“Birth control is an important medication that millions of people use every day,” said New York Attorney General Letitia James. “Denying health insurance coverage of birth control can cause serious health concerns for anyone who takes the medication. Reproductive health care is essential to the safety and wellbeing of New Yorkers, and it is crucial that health insurers abide by New York’s reproductive health care laws.”

The investigation revealed that UnitedHealthcare’s Oxford plan required patients to obtain prior authorization or step therapy for birth control, which violates the CCCA. These measures forced patients to go without necessary medication and imposed financial burdens.

Health insurers that deny, restrict or delay coverage of birth control impose unnecessary and unwarranted costs on patients, restrict access to reproductive care, and can force patients to skip or delay care due to financial barriers. Under the CCCA, health insurance plans must cover FDA-approved contraceptives without copays and remove any actions that might limit or delay access to care, including prior authorizations and step therapy.

As part of the settlement, UnitedHealthcare will ensure that all its health plans cover contraception without restrictions or delays. Additionally, the company will train all staff involved in claim approvals for contraception in compliance with New York laws.

UnitedHealthcare will reimburse all out-of-pocket costs paid by consumers for their birth control, plus 12 percent interest. Eligible consumers include those who paid for contraceptives that should have been covered without cost-sharing under the CCCA from June 1, 2020, onwards. Payments will be sent by mail, and those with potential claims will be notified and invited to submit a claim.