A.G. Schneiderman Announces Agreement With Albany Urgent Care Center That Misled Consumers About Its Participation In Unitedhealthcare Empire Plan

WorkFitMedical, LLC Will Pay Nearly $17,000 In Restitution To Consumers; Agrees To Enhance Disclosure Policy

Schneiderman: Consumers Deserve To Know Whether A Provider Is In-Network Or Out-Of Network

ALBANY—Attorney General Eric T. Schneiderman today announced an agreement with WorkFitMedical, LLC, a provider of occupational and urgent care services, to provide clear, detailed information to consumers about its participation with health plans.   The agreement is the result of an investigation into WorkFit, a health care company that had purchased an urgent care center in Albany. While attempting to contract with UnitedHealthcare/Empire Plan, WorkFit represented to consumers that it participated in UnitedHealthcare’s network, and then billed consumers for the entire cost of the visit - over and above the consumer's co-payment.  The agreement requires that WorkFit provide nearly $17,000 in restitution to consumers who paid for services rendered in excess of the amount of co-payment required by UnitedHealthcare/Empire Plan (Empire Plan) for seeing an in-network participating provider. WorkFit has also agreed to pay $12,500 in costs and penalties to the state.

“Consumers deserve to know whether a provider is in-network or out-of network so that they know the costs before they choose a medical provider,” said Attorney General Schneiderman. “My office will continue to make it a priority to ensure that New Yorkers aren’t duped by confusing and deceptive representations made by urgent care centers.”

The Attorney General’s investigation determined that for approximately 15 months, WorkFit represented to patients that it was in Empire’s network at a time when WorkFit did not yet have a contract with the Empire Plan, and so was “out-of-network.” As a result of being out-of-network, WorkFit balance billed 325 Empire Plan members in the amount of approximately $197,000 more than the member responsibility would have been if WorkFit had actually been in-network.   While WorkFit adjusted many patient bills after having been contacted by patients with complaints, the adjustments did not cover all Empire members who were improperly billed, and some members paid the bills.  Given WorkFit’s error, Empire Plan members were entitled to refunds of almost $17,000 and adjustments to zero of outstanding bills for those members whose accounts reflected a current outstanding balance. 

The facts underlying this case occurred before the New York “Surprise Bill Law,” which became effective on March 31, 2015, but serve as an example of a type of problem that the “Surprise Bill Law” is specifically designed to remedy.  The law requires, in part, that providers disclose in writing or through a website the health care plans in which the provider participates.  In addition, fee information must be made available to consumers so that consumers know in advance which providers participate in the health plan’s network, and the cost of services if the provider is out-of-network.

In addition to restitution and adjustment to patient accounts, the agreement requires WorkFit to strengthen disclosures and increase the instances of notification, including:

  • On its website, identify all health plans with which it has contracted to be an in-network participating provider.  If the center does not participate with all products that the health plan offers, it shall identify with specificity those insurance products for which it is an in-network, participating provider.
  • Post and provide the information in writing to the patient at the time of registration.
  • Cease using the term “works with” or “accepts” in relation to a health careplan.  Instead, the terms “in-network participating provider” or “out-of-network” will be used.  The centers shall also explain that “out-of-network” will lead to higher charges than in-network services.
  • Take steps to ensure the patient does not incur out-of-network costs if the required information is not communicated to the patient. 
  • Require all health care providers billing at the center to be an in-network participating provider with all health care plans with which the center contracts as an in-network participating provider.
  • Disclose to patients the availability of fee information, and, upon request, disclose to the patient the total cost for services that the center will bill the patient.

This agreement is part of the continuing work of the Attorney General to ensure health plans and health care providers clearly disclose critical information to consumers so that consumers can make the best choices for themselves and their families.  Recently, Attorney General Schneiderman entered into agreements with four urgent care centers to improve disclosure of accepted insurance plans.  The Health Care Bureau continues to work to make sure that consumers have information to make informed choices. 

The Attorney General’s Health Care Bureau helps consumers navigate the complex health care system, challenges insurers who won’t cover provided service, and targets organizations that have fraudulent, misleading or deceptive business practices. Consumers who believe they may have been treated unfairly by a health care provider, HMO or health insurance plan, should call the Attorney General’s Health Care Helpline at 800-428-9071.

The investigation of this matter was conducted by Assistant Attorney General Adrienne Lawston, of the Attorney General’s Health Care Bureau, which is led by Bureau Chief Lisa Landau. The Health Care Bureau is a part of the Social Justice Division, led by Executive Deputy Attorney General for Social Justice Alvin Bragg.

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