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Three R.I. health insurers pay over $1 million in fines for lapses in COVID coverage

Three R.I. health insurers pay over $1 million in fines for lapses in COVID coverage

Yahoo12-06-2025
Three Rhode Island health insurers were fined for charging patients out-of-pocket costs for pandemic-related care, such as emergency room care, doctor visits, and hospital stays, that should have been fully covered, the Office of the Health Insurance Commissioner said. (Getty image)
UnitedHealthcare paid $1 million and two Rhode Island health insurers paid lesser fines for violating state rules for health coverage of COVID-19 services.
Health Insurance Commissioner Cory King announced Thursday that his office had finished collecting fines charged to UnitedHealthcare, Blue Cross & Blue Shield of Rhode Island (BCBSRI) and Aetna. The insurers were penalized for charging patients out-of-pocket costs for pandemic-related care, such as emergency room care, doctor visits, and hospital stays — services that should have been fully covered under a 2021 rule promulgated by Patrick Tigue, King's predecessor in the the Office of the Health Insurance Commissioner (OHIC).
UnitedHealthcare incurred the heaviest fine while Blue Cross and Aetna were fined $20,000 and $10,000, respectively. Consent decrees for the insurance companies stipulated payment was due for UnitedHealthcare and Aetna on June 2, while Blue Cross needed to pay up by June 6. King said Thursday that the final payment was made last week.
'OHIC expects health insurance companies to comply with the law,' King wrote in an email. 'When they do not, they must take corrective actions and face consequences.'
The fines accumulated from July 3, 2021, when the rule was formalized into general law, through May 11, 2023, when Rhode Island's cost waiver rule expired and the COVID-19 public health emergency officially ended.
The cost waiver, however, only applied to fully insured plans, or coverage plans purchased by employers in which the insurer assumes the financial responsibility and risk. The cost mandate did not apply to people receiving services under self-insured plans — the kind of coverage often purchased by larger companies and held by about 60% of covered Rhode Islanders.
The three consent decrees OHIC released Thursday detail the scope of violations and how the insurers fixed their billing problems. UnitedHealthcare's hefty $1 million fine derived from 1,545 claims in which Rhode Island plan members were wrongly charged for COVID-related care. In 2023, the company reprocessed the claims and refunded roughly $270,000 to affected members.
'We are pleased to have resolved this issue with the Rhode Island Office of the Health Insurance Commissioner,' Bradley J. Alexander, a spokesperson for United, said in an email Thursday. 'We remain focused on helping individuals access care while supporting our employees, our network of care providers, our clients and the communities we serve.'
The Blue Cross case was less straightforward. The insurer had already waived cost-sharing for COVID treatment in April 2020, according to spokesperson Rich Salit.
'BCBSRI's cost-share waiver applied to all in-network services and out-of-network services received outside of Rhode Island,' Salit wrote. 'For services in Rhode Island, BCBSRI was encouraging members to seek care from our broad network, as members going out-of-network could still be exposed to provider balance billing.'
Balance billing is when out-of-network providers charge patients for what insurance didn't pay.
According to the consent decree, Blue Cross believed its policy complied with the OHIC statute, at first indicating 'that it was not waiving cost sharing on services related to the treatment of COVID-19 if such services were provided by out-of-network providers within Rhode Island.'
Nevertheless, OHIC did not agree with that interpretation, penalized the company for not covering the out-of-network care in 19 claims. Blue Cross was required to pay $1,751.60 in refunds, plus the $20,000 fine. Salit said the claims came from eight plan members.
'BCBSRI agreed to reimburse the cost sharing those members incurred and updated its policy, and the matter was resolved,' Salit wrote.
Aetna, a subsidiary of CVS, only had three claims flagged under the OHIC rule.
'We are pleased this agreement resolves issues with the OHIC related to three (3) Aetna claims, which we reprocessed in 2022,' Phillip J. Blando, an Aetna spokesperson, wrote via email.
The penalty money goes into the state's general fund, according to OHIC.
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BioNTech is the Marketing Authorization Holder for COMIRNATY® and its adapted vaccines in the United States, the European Union, the United Kingdom, and other countries, and the holder of emergency use authorizations or equivalents in the United States (jointly with Pfizer) and other countries. US INDICATION, AUTHORIZED USE AND IMPORTANT SAFETY INFORMATION US INDICATION COMIRNATY® (COVID-19 Vaccine, mRNA) is a vaccine for use in people 12 years of age and older to protect against coronavirus disease 2019 (COVID-19). IMPORTANT SAFETY INFORMATION You should NOT get COMIRNATY® (COVID-19 Vaccine, mRNA) if you had a severe allergic reaction to a previous dose of COMIRNATY or any Pfizer-BioNTech COVID-19 vaccine or to any ingredient in these vaccines There is a remote chance that COMIRNATY could cause a severe allergic reaction. A severe allergic reaction would usually occur within a few minutes to 1 hour after getting a dose. 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Ask your healthcare provider about any side effects that concern you. You may report side effects to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS). The VAERS toll-free number is 1‐800‐822‐7967 or report online to In addition, you can report side effects to Pfizer Inc. at 1-800-438-1985 or Please click here for full Prescribing Information and Patient Information for COMIRNATY AUTHORIZED USE Pfizer-BioNTech COVID-19 Vaccine (2024-2025 Formula)* is FDA authorized under Emergency Use Authorization (EUA) to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 6 months through 11 years of age. *Hereafter referred to as Pfizer-BioNTech COVID-19 Vaccine. 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A severe allergic reaction would usually occur within a few minutes to one hour after getting a dose of the vaccine. For this reason, the vaccination provider may ask you to stay at the place where you received the vaccine for monitoring after vaccination. If your child experiences a severe allergic reaction, call 9-1-1, or go to the nearest hospital. Signs of a severe allergic reaction can include: difficulty breathing, swelling of the face and throat, a fast heartbeat, a bad rash all over the body, or dizziness and weakness Myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) have occurred in some people who have received mRNA COVID-19 vaccines including Pfizer-BioNTech COVID-19 Vaccine. Myocarditis and pericarditis following administration of mRNA COVID-19 vaccines have occurred most commonly in males 12 years through 24 years of age. In most of these people, symptoms began within a week following vaccination. Seek medical attention right away if your child has any of the following symptoms after receiving the vaccine, particularly during the 2 weeks after receiving a dose of the vaccine: Chest pain Shortness of breath or difficulty breathing Feelings of having a fast-beating, fluttering, or pounding heart Additional symptoms, particularly in children, may include: Fainting Unusual and persistent irritability Unusual and persistent poor feeding Unusual and persistent fatigue or lack of energy Persistent vomiting Persistent pain in the abdomen Unusual and persistent cool, pale skin Fainting can happen after getting injectable vaccines, including Pfizer-BioNTech COVID-19 Vaccine. For this reason, your vaccination provider may ask you to stay at the place where you received the vaccine for monitoring after vaccination People with weakened immune systems may have a reduced immune response to Pfizer- BioNTech COVID-19 Vaccine Pfizer-BioNTech COVID-19 Vaccine may not protect everyone Tell your vaccination provider about all of your child's medical conditions, including if your child: has any allergies has had myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the lining outside the heart) has a fever has a bleeding disorder or is on a blood thinner is immunocompromised or is on a medicine that affects the immune system is pregnant or is breastfeeding has received another COVID-19 vaccine has ever fainted in association with an injection Side effects that have been reported with Pfizer-BioNTech COVID-19 vaccines include: Severe allergic reactions Non-severe allergic reactions such as rash, itching, hives, or swelling of the face Myocarditis (inflammation of the heart muscle) Pericarditis (inflammation of the lining outside the heart) Injection site pain/tenderness Tiredness Headache Muscle pain Chills Joint pain Fever Injection site swelling Injection site redness Nausea Feeling unwell Swollen lymph nodes (lymphadenopathy) Decreased appetite Diarrhea Vomiting Arm Pain Fainting in association with injection of the vaccine Dizziness Irritability Febrile seizures (convulsions during a seizure) These may not be all the possible side effects. Serious and unexpected side effects may occur. Call the vaccination provider or healthcare provider about bothersome side effects or side effects that do not go away. Report vaccine side effects to the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS). The VAERS toll-free number is 1‐800‐822‐7967 or report online to Please include "Pfizer-BioNTech COVID-19 Vaccine (2025-2026 Formula) EUA" in the first line of box #18 of the report form. In addition, individuals can report side effects to Pfizer Inc. at or by calling 1-800-438-1985. Please click here for Pfizer-BioNTech COVID-19 Vaccine Healthcare Providers Fact Sheet and Vaccine Recipient and Caregiver EUA Fact Sheet. About Pfizer: Breakthroughs That Change Patients' LivesAt Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products, including innovative medicines and vaccines. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For 175 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at In addition, to learn more, please visit us on and follow us on X at @Pfizer and @Pfizer News, LinkedIn, YouTube and like us on Facebook at Pfizer Disclosure NoticeThe information contained in this release is as of July 24, 2025. Pfizer assumes no obligation to update forward-looking statements contained in this release as the result of new information or future events or developments. This release contains forward-looking information about Pfizer's efforts to combat COVID-19, the collaboration between BioNTech and Pfizer to develop a COVID-19 vaccine, the BNT162b2 mRNA vaccine program, and the Pfizer-BioNTech COVID-19 Vaccine, also known as COMIRNATY® (COVID-19 Vaccine, mRNA) (BNT162b2) including an Omicron-adapted monovalent COVID-19 vaccine candidate, based on the LP.8.1 lineage, including the receipt of a positive CHMP opinion from the European Medicines Agency (EMA) for an Omicron-adapted monovalent COVID-19 vaccine, based on the LP.8.1 lineage, expectations regarding the demand for COVID-19 vaccines, planned regulatory submissions, qualitative assessments of available data, potential benefits, expectations for clinical trials, potential regulatory submissions, the anticipated timing of data readouts, regulatory submissions, regulatory approvals or authorizations and anticipated availability, manufacturing, distribution and supply involving substantial risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Risks and uncertainties include, among other things, the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as risks associated with preclinical and clinical data (including Phase 1/2/3 or Phase 4 data), any monovalent or bivalent vaccine candidates or any other vaccine candidate in the BNT162 program in any of our studies in pediatrics, adolescents, or adults or real world evidence, including the possibility of unfavorable new preclinical, clinical or safety data and further analyses of existing preclinical, clinical or safety data; the ability to produce comparable clinical or other results, including the rate of vaccine effectiveness and safety and tolerability profile observed to date, in additional analyses of the Phase 3 trial and additional studies, in real world data studies or in larger, more diverse populations following commercialization; the ability of BNT162b2, any monovalent or bivalent vaccine candidates or any future vaccine to prevent COVID-19 caused by emerging virus variants; the risk that more widespread use of the vaccine will lead to new information about efficacy, safety, or other developments, including the risk of additional adverse reactions, some of which may be serious; the risk that preclinical and clinical trial data are subject to differing interpretations and assessments, including during the peer review/publication process, in the scientific community generally, and by regulatory authorities; whether and when additional data from the BNT162 mRNA vaccine program will be published in scientific journal publications and, if so, when and with what modifications and interpretations; whether regulatory authorities will be satisfied with the design of and results from these and any future preclinical and clinical studies; whether and when submissions to request emergency use or conditional marketing authorizations for BNT162b2 in additional populations, for a potential booster dose for BNT162b2, any monovalent or bivalent vaccine candidates or any potential future vaccines (including potential future annual boosters or re-vaccination), and/or other biologics license and/or emergency use authorization applications or amendments to any such applications may be filed in particular jurisdictions for BNT162b2, any monovalent or bivalent vaccine candidates or any other potential vaccines that may arise from the BNT162 program, including a potential variant-based, higher dose, or bivalent vaccine, and if obtained, whether or when such emergency use authorizations or licenses will expire or terminate; whether and when any applications that may be pending or filed for BNT162b2 (including any requested amendments to the emergency use or conditional marketing authorizations), any monovalent or bivalent vaccine candidates, or other vaccines that may result from the BNT162 program may be approved by particular regulatory authorities, which will depend on myriad factors, including making a determination as to whether the vaccine's benefits outweigh its known risks and determination of the vaccine's efficacy and, if approved, whether it will be commercially successful; decisions by regulatory authorities impacting labeling or marketing, manufacturing processes, safety and/or other matters that could affect the availability or commercial potential of a vaccine, including development of products or therapies by other companies; disruptions in the relationships between us and our collaboration partners, clinical trial sites or third-party suppliers; risks and uncertainties related to potential changes to vaccine or other healthcare policy in the U.S.; the risk that demand for any products may be reduced or no longer exist or not meet expectations which may lead to reduced revenues or excess inventory on-hand and/or in the channel; uncertainties related to recommendations and coverage for, and the public's adherence to vaccines, boosters, treatments or combinations; risks related to our ability to accurately predict or achieve our revenue forecasts for our COVID-19 vaccine or any potential future COVID-19 vaccines; potential third-party royalties or other claims related to our COVID-19 vaccine; the risk that other companies may produce superior or competitive products; risks related to the availability of raw materials to manufacture or test a vaccine; challenges related to our vaccine's formulation, dosing schedule and attendant storage, distribution and administration requirements, including risks related to storage and handling after delivery by Pfizer; the risk that we may not be able to successfully develop other vaccine formulations, booster doses or potential future annual boosters or re-vaccinations or new variant-based vaccines or combination vaccines; the risk that we may not be able to maintain or scale up manufacturing capacity on a timely basis or maintain access to logistics or supply channels commensurate with global demand for our vaccine, which would negatively impact our ability to supply the estimated numbers of doses of our vaccine within the projected time periods as previously indicated; whether and when additional supply agreements will be reached; uncertainties regarding the ability to obtain or maintain recommendations from vaccine advisory or technical committees and other public health authorities and uncertainties regarding the commercial impact of any such recommendations, including uncertainties related to the potential impact of narrowing recommended patient populations; challenges related to public vaccine confidence or awareness; risks and uncertainties related to issued or future executive orders or other new, or changes in, laws or regulations; uncertainties regarding the impact of COVID-19 on Pfizer's business, operations and financial results; and competitive developments. A further description of risks and uncertainties can be found in Pfizer's Annual Report on Form 10-K for the fiscal year ended December 31, 2024 and in its subsequent reports on Form 10-Q, including in the sections thereof captioned "Risk Factors" and "Forward-Looking Information and Factors That May Affect Future Results", as well as in its subsequent reports on Form 8-K, all of which are filed with the U.S. Securities and Exchange Commission and available at and About BioNTechBiopharmaceutical New Technologies (BioNTech) is a global next generation immunotherapy company pioneering novel investigative therapies for cancer and other serious diseases. BioNTech exploits a wide array of computational discovery and therapeutic modalities with the intent of rapid development of novel biopharmaceuticals. Its diversified portfolio of oncology product candidates aiming to address the full continuum of cancer includes mRNA cancer immunotherapies, next-generation immunomodulators and targeted therapies such as antibody-drug conjugates (ADCs) and innovative chimeric antigen receptor (CAR) T cell therapies. Based on its deep expertise in mRNA development and in-house manufacturing capabilities, BioNTech and its collaborators are researching and developing multiple mRNA vaccine candidates for a range of infectious diseases alongside its diverse oncology pipeline. BioNTech has established a broad set of relationships with multiple global and specialized pharmaceutical collaborators, including Bristol Myers Squibb, Duality Biologics, Fosun Pharma, Genentech, a member of the Roche Group, Genevant, Genmab, MediLink, OncoC4, Pfizer and more information, please visit BioNTech Forward-looking StatementsThis press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, as amended, including, but not be limited to, statements concerning: BioNTech's efforts to combat COVID-19; the collaboration between BioNTech and Pfizer; the rate and degree of market acceptance of BioNTech's COVID-19 vaccine, including the LP.8.1-adapted monovalent COVID-19 vaccine; qualitative assessments of available data and expectations of potential benefits, including the adapted vaccine's response against multiple SARS-CoV-2 lineages, including NB.1.8.1 and other currently circulating sublineages; regulatory submissions and regulatory approvals or authorizations and expectations regarding manufacturing, distribution and supply; expectations regarding anticipated changes in COVID-19 vaccine demand, including changes to the ordering environment; and expected regulatory recommendations to adapt vaccines to address new variants or sublineages. In some cases, forward-looking statements can be identified by terminology such as "will," "may," "should," "expects," "intends," "plans," "aims," "anticipates," "believes," "estimates," "predicts," "potential," "continue," or the negative of these terms or other comparable terminology, although not all forward-looking statements contain these words. The forward-looking statements in this press release are neither promises nor guarantees, and you should not place undue reliance on these forward-looking statements because they involve known and unknown risks, uncertainties, and other factors, many of which are beyond BioNTech's control and which could cause actual results to differ materially from those expressed or implied by these forward-looking statements. These risks and uncertainties include, but are not limited to: the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as risks associated with preclinical and clinical data, including the data discussed in this release, and including the possibility of unfavorable new preclinical, clinical or safety data and further analyses of existing preclinical, clinical or safety data; the nature of the clinical data, which is subject to ongoing peer review, regulatory review and market interpretation; BioNTech's pricing and coverage negotiations with governmental authorities, private health insurers and other third-party payors after BioNTech's initial sales to national governments; the future commercial demand and medical need for initial or booster doses of a COVID-19 vaccine; the impact of tariffs and escalations in trade policy; the availability of raw materials to manufacture a vaccine; our vaccine's formulation, dosing schedule and attendant storage, distribution and administration requirements, including risks related to storage and handling after delivery; competition from other COVID-19 vaccines or related to BioNTech's other product candidates, including those with different mechanisms of action and different manufacturing and distribution constraints, on the basis of, among other things, efficacy, cost, convenience of storage and distribution, breadth of approved use, side-effect profile and durability of immune response; the ability to obtain recommendations from vaccine advisory or technical committees and other public health authorities and uncertainties regarding the commercial impact of any such recommendations; the timing of and BioNTech's ability to obtain and maintain regulatory approval for BioNTech's product candidates; the ability of BioNTech's COVID-19 vaccines to prevent COVID-19 caused by emerging virus variants; BioNTech's and its counterparties' ability to manage and source necessary energy resources; BioNTech's ability to identify research opportunities and discover and develop investigational medicines; the ability and willingness of BioNTech's third-party collaborators to continue research and development activities relating to BioNTech's development candidates and investigational medicines; the impact of COVID-19 on BioNTech's development programs, supply chain, collaborators and financial performance; unforeseen safety issues and potential claims that are alleged to arise from the use of BioNTech's COVID-19 vaccine and other products and product candidates developed or manufactured by BioNTech; BioNTech's and its collaborators' ability to commercialize and market BioNTech's COVID-19 vaccine and, if approved, its product candidates; BioNTech's ability to manage its development and related expenses; regulatory developments in the United States and other countries; BioNTech's ability to effectively scale BioNTech's production capabilities and manufacture BioNTech's products, including BioNTech's target COVID-19 vaccine production levels, and BioNTech's product candidates; risks relating to the global financial system and markets; and other factors not known to BioNTech at this time. You should review the risks and uncertainties described under the heading "Risk Factors" in BioNTech's Report on Form 6-K for the period ended March 31, 2025, and in subsequent filings made by BioNTech with the SEC, which are available on the SEC's website at These forward-looking statements speak only as of the date hereof. Except as required by law, BioNTech disclaims any intention or responsibility for updating or revising any forward-looking statements contained in this press release in the event of new information, future developments or otherwise. [Category: Vaccines] 1 Vaccines and Related Biological Products Advisory Committee. 22 May 2025. Meeting Presentation- 2025-2026 COVID-19 Vaccine Formula: Pfizer/BioNTech Supportive Data. Available at: Accessed 13 June 2025.2 European Medicines Agency (EMA) ETF recommends updating COVID-19 vaccines to target new LP.8.1. 16 May 2025. Available at: Accessed 13 June 2025. View source version on Contacts Pfizer: Media Relations+1 (212) 733-1226PfizerMediaRelations@ Investor Relations+1 (212) 733-4848IR@ BioNTech: Media RelationsJasmina Alatovic+49 (0)6131 9084 1513Media@ Investor RelationsVictoria Meissner, M.D.+1 (617) 528-8293Investors@

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