News & Observer | newsobserver.com | United HealthCare fined $800,000

Published: Jul 24, 2008 12:29 PM
Modified: Jul 24, 2008 02:13 PM

United HealthCare fined $800,000

 

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United HealthCare Insurance Co. and UnitedHealthCare of North Carolina Inc. have agreed to pay the state nearly $800,000 to resolve allegations that the two companies violated North Carolina law.

The N.C. Department of Insurance announced the settlement today. The money will go to the state's public schools, as required by state law.

UnitedHealthcare issued a statement today in response to the Department of Insurance’s announcement of the settlement agreement.

“Today’s agreement provides a meaningful way to assess how we measure up to the high standards of service that people in North Carolina expect," the statement said. "It also builds on the steps that UnitedHealthcare is taking in North Carolina as part of a broader, national effort to ensure the company provides access to high-quality, affordable health care and the best possible service.”

“The agreement also resolves allegations related to regulatory matters in North Carolina related to the areas of review...," the statement said.

The case began in 2003 when North Carolina consumers and doctors complained about the insurance companies, the release said.

The Insurance Department then scrutinized the two companies and discovered numerous problems with the companies' claims handling process. The companies were not settling claims quickly enough and were not giving patients the correct amount, said Chrissy Pearson, a spokeswoman for the Department of Insurance.

The department fined the companies $2.2 million as part of a settlement agreement in 2004. It was the highest such fine ever levied by the Department of Insurance.

After the 2004 settlement, other states began looking into the companies. They discovered more problems with the companies' claims processing, settlement and payment as well as their coordination of benefits; appeals, grievances and complaint resolution; explanation of benefits; provider networks; and management, according to a news release from the Insurance Department.

Thirty-nine states and the District of Columbia settled reached a settlement with the companies over these violations earlier this year. North Carolina did not participate in that settlement because it would have restricted the department's scrutiny over the companies.

The Department of Insurance said the settlement gives it flexibility to address future issues as they arise.

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