FOUL PLAY

Insurance company mistreatment

Every time an insurance company pays a medical bill it considers it a “loss.” Is it any wonder they will do anything they can to avoid such “losses?” They have often even resorted to breaking the law.

Here are just a few examples of how one of the largest insurance companies in the country, United Healthcare, has continuously flouted state laws in its handling of medical claims:

• The North Carolina Department of Insurance found United Healthcare Insurance Co. and United Healthcare of North Carolina Inc. was delaying prompt payment of medical claims and not giving patients the correct amount. United HealthCare agreed to pay nearly $800,000 in fines.


• The Texas Department of Insurance fined United Healthcare $4.4 million for violating the state's prompt payment law. It found the company did not pay "clean" claims on time. This was the second time in two years and the fourth time since 2001 that the state of Texas had to fine United Healthcare for the same problem.


• The Arizona Department of Insurance ordered United Healthcare to pay civil penalties totaling $364,750 for illegally denying more than 63,000 claims by doctors without receiving all of the information needed to accept or deny a claim and for failing to follow state laws for promptly notifying doctors and patients about decisions and appeals.


• An examination by the Georgia insurance department found that United Healthcare was late with between 75,000 and 80,000 claims in accordance with Georgia’s law that requires prompt payment. In response to the findings, the Georgia Office of the Insurance and Fire Safety Commissioner fined United Healthcare and sister companies United Healthcare of Georgia Inc. and Golden Rule Insurance Co., $2.8 million. The company was fined for similar delinquencies in 2000 and 2002.

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