In the Matter of EmblemHealth

EmblemHealth allegedly improperly denied coverage of gender reassignment surgery to a member based on failure to meet EmblemHealth’s unlawful criteria, according to NY-AG. EmblemHealth's Gender Reassignment Guidelines appears to have been outdated and not evidence-based during the time they remained in effect, according to NY-AG. Emblemhealth allegedly provided misleading and deceptive information to plan members indicating that the Guidelines were based on current clinical information and standard medical guidelines when they were not, according to NY-AG.

Summary generated from official New York Attorney General press release