PROVIDENCE – The R.I. Office of the Health Insurance Commissioner on Thursday fined three health insurers a total of $1.03 million for violating state laws that required the waiver of cost-sharing for COVID-19-related services.
During its monitoring of insurer compliance, OHIC determined that UnitedHealthcare of New England, Blue Cross & Blue Shield of Rhode Island and Aetna Inc. each failed to fully adhere to the law, which was effective for the duration of the public health state of emergency that ended in May 2023.
Per state law, in July 2021 insurers offering fully insured health benefit plans were required to waive cost sharing, including copayments, coinsurance and deductibles for COVID-19- related services. Those included emergency services, inpatient services, provider office visits and inpatient hospital stays.
These violations, according to OHIC, included applying cost-sharing for COVID-19-related services in situations where it was prohibited, such as for out-of-network care or for in-network services that should have been covered in full.
In some cases, insurers failed to implement policies to ensure a consistent waiver of cost-sharing, resulting in members being improperly charged copayments, coinsurance or deductibles for covered services.
The fine payments will be deposited into the state’s general fund, OHIC said.
“BCBSRI voluntarily waived member cost-sharing for COVID treatment starting in April of 2020, before state law requiring it went into effect in July 2021. BCBSRI’s cost-share waiver applied to all in-network services and out-of-network services received outside of Rhode Island," Blue Cross spokesperson Rich Salit said in an email to Providence Business News on Thursday. "For services in Rhode Island, BCBSRI was encouraging members to seek care from our broad network, as members going out-of-network could still be exposed to provider balance billing."
Salit added, "The OHIC inquiry identified eight members who received out-of-network services in Rhode Island, with cost-sharing totaling approximately $1,750. BCBSRI agreed to reimburse the cost sharing those members incurred and updated its policy, and the matter was resolved.”
Phillip Blando, spokesperson for CVS Health Corp., said the company is "pleased this agreement resolves issues with the OHIC related to three Aetna claims, which we reprocessed in 2022."
UnitedHealthcare did not immediately respond to requests for comment.
(ADDS penultimate paragraph with CVS comment.)
