The state attorney general’s office has reached a settlement with AXA Equitable Life Insurance Co. following an investigation into the company’s medical reimbursements from September 2011 to May 2012.
During that time, AXA Equitable used data from a third party to reimburse medical claims, according to the attorney general’s office. As a result, medical reimbursements were lowered for some members.
“These consumers paid their bills and played by the rules, only to discover their insurance policies had changed with no warning by AXA Equitable,” New York State Attorney General Eric Schneiderman said in a news release. “At the very least, consumers should expect that the terms of their health plans are honored. It is unacceptable for AXA Equitable to switch its claim-reimbursement policy to one that pays less without alerting plan members.”
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In the settlement, AXA Equitable agreed to reimburse consumers’ medical claims, file a report with the attorney general’s office on its restitution process, pay the office $30,000 to cover the costs of its investigation, and Employ Fair Health, Inc. as the data source for its medical claims reimbursement policy.
Fair Health is a not-for-profit organization that handles health-care charge information. It was established in October 2009 as part of another of the attorney general’s settlements that dealt with the health-insurance industry’s methods for determining out-of-network reimbursements.
The attorney general’s office estimated reimbursing consumers could cost AXA Equitable a maximum of nearly $850,000.
The company said 773 claims may have been affected. A company spokesperson released the following statement:
“AXA Equitable is committed to doing what is right for our customers. Our intention always was to pay claims at the reasonable and customary rate. As of June 1, we moved to the Fair Health protocol for future claims from our small, closed block of major medical insurance clients. We are looking back at all claims paid from September 2011 through May 2012, and if any of our customers incurred shortfalls, we will pay those shortfalls at 100 percent. The company fully cooperated with the Attorney General’s office and the Department of Financial Services.”
AXA Equitable Life Insurance Co. is part of the Paris–based AXA Group. The group has offices in the AXA Towers at 120 Madison St. in Syracuse.
Contact Seltzer at rseltzer@cnybj.com
