NY-AG v. EmblemHealth

EmblemHealth's process of updating criteria for gender reassignment surgery was deficient, according to NY-AG. The criteria included in the 2014-2017 Guidelines were outdated and not medically accurate or evidence-based during the time they remained in effect. EmblemHealth's review of member requests, including coverage for mammoplasty as part of gender reassignment surgery, was deficient, according to NY-AG. EmblemHealth provided misleading and deceptive information to plan members indicating that its 2014-2017 Gender Reassignment Surgery 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