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Washington Insurance Commissioner Mike Kreidler has announced LifeWise Health Plan of Washington and Evolent Health LLC will pay $225,000 in fines for gender discrimination in approving health insurance claims.

Kreidler fined LifeWise $150,000 and Evolent (LifeWise’s health care benefit manager) $75,000 in orders filed on Sep. 12 after a patient filed a claim for reproductive care with LifeWise in 2022 and was denied a week later.

The patient was told the requested procedure was atypical for their gender and that they would need to produce additoinal medical records to reprocess the claim, the Office of the Insurance Commissioner reports.

The provider’s office, according to the OIC, contacted LifeWise about the claim and got the same response, and the patient contacted LifeWise twice more to no avail before giong to Kreidler's office.

Four days after the patient filed a complaint with the OIC, the patient was told by LifeWise their claim would be reprocessed and paid, Kreidler's office reports.

“A patient shouldn’t need to spend the better part of a year asking their insurance plan to correct an error,” Kreidler said. “Providing them with an explanation that breaks Washington state law is unacceptable.”

The OIC found 40 claims of over $318,700 at Lifewise had been improperly denied based on the patient's gender. The total allowed amount for the 27 unique claims was $17,821. The impacted claims have since been paid, according to the OIC.

Thirty-one of those 40 claims were denied by Evolent acting on behalf of LifeWise, the OIC reports.

The original patient filed another complaint against LifeWise in January of 2023 alleging another denial based on gender discrimination, according to the OIC. LifeWise, the OIC reports, corrected that claim later that month.

Under state law, health insurers may not issue automatic denials or limit coverage for reproductive care that is ordinarily or exclusively available to one gender, even if the patient is of a different gender, according to the OIC.