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Insurers fined for faulty claims processing

Posted July 24, 2008

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— The state Department of Insurance has fined United HealthCare Insurance Co. and United HealthCare of North Carolina Inc. to resolve allegations that the insurers violated state law with the way they processed consumer claims.

The $786,656 fine ends an investigation by the state Department of Insurance into the two companies that began five years ago, officials said.

Consumers and health care providers began complaining to state regulators in 2003 and 2004 about United HealthCare's handling of medical insurance claims, officials said. The state fined the companies as part of a 2004 settlement.

The investigation prompted other states to investigate United HealthCare's operations, and 39 states and the District of Columbia signed an agreement with the insurer this year to resolve similar allegations nationwide.

State regulators signed a new settlement agreement with United HealthCare this week, including the fine, to reflect the multi-state agreement, officials said.

"While the DOI is focusing on the settlement via a fine, from UHC's perspective, this addesses settling past issues and concerns and lays a framework for dealing with claims payment, etc. in the future," United HealthCare said in a statement.


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  • catwoman1 Jul 25, 2008

    You'd think so. My son was on UHC during this time with many out-of-pocket expenses because his physicians got fed up with not being reimbursed and they pulled out of the plan. Participating providers in PPO plans are not required to notify patients either unlike HMOs. We met the deductible ($2500.00) and still were told we had to pay coinsurance on top of that. UHC used to be a good company years ago. I feel certain that UHC will review these claims, but it won't be an overnight thing.

  • Adelinthe Jul 24, 2008


    God bless.

    Rev. RB

  • IzzMad2016 Jul 24, 2008

    catwoman1 : I was wondering the very same thing. Co-pays and deductibles are outrageous and I can't imagine that those of us insured by UHC aren't due something. Surely the fine goes hand-in-hand with reimbursement!

  • catwoman1 Jul 24, 2008

    My question is...is UHC going to review these old claims and hopefully reimburse PROPERLY the physicians, ancillaries, and members??? A hefty fine is one thing, but they need to rectify the claims as well. Good work DOI.