Effective November 19, 2018, the Centers for Medicare and Medicaid Services (CMS) imposed intermediate sanctions on Quality Health Plans of New York (QHPNY). This means that QHPNY can not accept new enrollments into our plan and/or market to enrollees, at this time.
There were four reasons QHPNY was sanctioned:
- Failing to meet CMS financial requirements.
- Failing to file these financial statements timely.
- Failing to pay 95% of out-of-network providers within 60 days.
- Failing to notify out-of-network providers of claim denial decisions within 60 days after receipt of service requests.
If you are a current QHPNY member, the benefits you have as a member of your current plan will not be affected in any way and will continue while QHPNY is sanctioned. You still have access to our providers and pharmacy network and coverage for medical services and drugs on our formulary.
QHPNY is working diligently to resolve these issues as quickly as possible and we apologize for the inconvenience.