Confidentiality for Victims of Domestic Violence
You have the right to request that claim-related communications from your health insurer be sent to you in alternative ways if disclosing the information could endanger you. “Claim-related information” means claim or billing information relating specifically to you, including your name, address, any services you received, and the name and address of your provider or doctor. Your request will remain in effect until you revoke it.
- Learn more about these confidentiality requirements.
- Read a sample confidential communication request form that a health insurer may ask you to submit.
Appealing a Denial of a Health Care Service
If your insurer or HMO denies health care services as not medically necessary, experimental/investigational or out-of-network, you have the right to appeal to the Department of Financial Services. This appeal is known as an External Appeal. Health care providers also have the right to appeal when health care services are denied.
- Learn how to file an External Appeal.
- Search prior appeal decisions using our External Appeals Database.
Designating a Representative For Assistance with Health Insurance Authorizations, Complaints, Grievances, and Appeals
If you need assistance with a preauthorization request, complaint, grievance, or appeal with your health insurer, you can designate a person or persons or organization to assist you by completing the form and submitting it to the address or fax number on your member identification card or other method specified by your insurer.
Prescription Drug Prices
DFS investigates significant price increases for certain drugs sold or advertised in New York State, and requires companies to show reasonable justification for sudden increases.
- Learn how to report a spike in a prescription drug price
Health Insurance Premiums and Rate Increases
Health insurers must apply to DFS with proposed rate changes. DFS reviews the application and the insurer’s calculations to make sure that rate increases are justified and not excessive. During review, DFS may consider comments from policyholders or the public. Rate applications can be found here:
- Learn more about Health Insurance Premiums and Applications for Rate Increases.
Mental Health and Substance Use
- Learn more about Mental Health and Substance Use Disorder coverage in New York
Infertility, Fertility Preservation, and Surrogacy
- FAQs for Infertility Services, Fertility Preservation Services, and Health Care Services Related to Surrogacy
Child Health Plus
Every child in New York who is under age 19 who does not have health insurance is eligible for the Child Health Plus program. Visit the Department of Health for more information on Child Health Plus or call (800) 698-4543 or your local department of social services or department of health.
DFS oversees the Healthy NY program in partnership with HMOs and other insurance companies in New York State, to offer comprehensive health insurance to small businesses.
Accident & Health Insurance Form Filings
Certain accident & health insurance policy filings are available for public viewing online on the SERFF State Filing Access website. Filings may be updated or changed by a subsequent filing. You should search for the most recent version of the filing. The Department is not responsible for any errors in or omissions from the filings. The public may also request filings by submitting a Freedom of Information Law (FOIL) request to the Department.