UnitedHealthcare to Pay $1 Million Penalty for Failing to Cover Birth Control for New York Patients, Will Refund Those Who Were Denied Coverage and Paid Out-of-Pocket
New York Attorney General Letitia James secured $1 million from UnitedHealthcare of New York, Inc. (UnitedHealthcare), the country’s largest health insurer, for failing to provide coverage of birth control through its health plans. The Office of the Attorney General (OAG) received a complaint from a patient in Brooklyn who was denied coverage for their oral contraceptive by UnitedHealthcare’s Oxford health plan, in violation of New York’s Comprehensive Contraceptive Coverage Act (CCCA). The CCCA requires health insurance plans to cover FDA-approved contraceptives without copays, restrictions, or delays. In addition to paying a $1 million penalty, UnitedHealthcare will refund consumers who were denied coverage by any of its health plans and were forced to pay out-of-pocket costs to purchase their prescribed birth control. Eligible consumers will receive payment in the mail and those with potential claims will be notified and asked to submit a claim. Consumers covered by UnitedHealthcare who paid for contraception and believe they should have been covered in full may submit a claim by emailing UHC_NYContraceptives_support@uhc.com. UnitedHealthcare must also ensure that all its health plans are covering birth control without restrictions or delays as required by the CCCA.
“Birth control is an important medication that millions of people use every day,” said Attorney General 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. I encourage anyone who may have had their birth control coverage denied by their health insurance company to contact my office and file a complaint. New Yorkers can rest assured that my office will always protect access to reproductive health care.”
The OAG’s Health Care Bureau opened an investigation into UnitedHealthcare after receiving a complaint from a patient that their prescription oral contraceptive was denied coverage by UnitedHealthcare’s Oxford plan. The patient's appeal was rejected, and the health plan required the patient to obtain prior authorization or step therapy, a process requiring patients to try alternative treatments. UnitedHealthcare’s denial of coverage and further delays forced the patient to go without their birth control and violated New York’s CCCA.
Health insurers that deny, restrict, or delay coverage of birth control impose unnecessary and unwarranted costs for patients, restrict equitable access to reproductive care, and force patients to skip or delay care because of financial barriers. Under New York’s CCCA, health insurance plans are required to cover FDA-approved contraceptives without copays and to remove any actions that might limit or delay access to care, including prior authorizations, step therapy, and exception processes. The CCCA also requires health insurers to cover at least one version of approved contraceptives if there are multiple therapeutically equivalent drugs.
As a result of this settlement, UnitedHealthcare will pay a $1 million penalty and ensure that all of its health plans are covering contraception without copays, restrictions, or delays as required by New York’s CCCA. Additionally, UnitedHealthcare will ensure all staff involved in the claim approvals process for contraception are trained on compliance with New York laws.
The settlement also requires UnitedHealthcare to reimburse all out-of-pocket costs paid by consumers for their birth control, plus 12 percent interest. Eligible consumers include patients who paid a copay for contraceptives that should have been covered without cost sharing under CCCA from June 1, 2020 onwards. Eligible consumers will receive payment in the mail and those with potential claims will receive notice inviting them to submit a claim. Consumers covered by UnitedHealthcare who paid for contraception and believe they should have been covered in full may submit a claim to UnitedHealthcare by emailing UHC_NYContraceptives_support@uhc.com. In the claim, patients should list the exact type of contraception, approximate date(s) of the claims for coverage, and the amount they believe they overpaid.
Today’s settlement is the latest action taken by Attorney General James to protect access to reproductive healthcare. In May 2024, Attorney General James announced a sweeping lawsuit against an anti-abortion group and 11 crisis pregnancy centers claiming to offer medically unfounded abortion reversal treatments, building on her previous work in shutting down abortion clinic protestors who were harassing patients trying to get care. In April 2024, Attorney General James led a coalition of 21 Attorney Generals across the country calling on Congress to expand access to IVF. Attorney General James has continued to lead fellow attorney generals across the country in protecting reproductive health, leading amicus briefs at the Supreme Court calling on the court to protect emergency abortion services and access to medication abortion, as well as leading efforts to stand up to states criminalizing those who help others access abortions.
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