Geisinger Health Plan fined $125K for wrongly rejected claims

Danville, Pa.-based Geisinger Health Plan has been fined $125,000 for wrongly rejecting health insurance claims, PennLive reported Jan. 27. 

The Pennsylvania Insurance Department uncovered the issues during routine audits, according to the report. Many of the wrongful denials involved mental healthcare and substance abuse treatment.  

The department said it found problems involving unclear communications with customers and incorrect calculations related to maximum out-of-pocket costs, according to the report. It also found violations of the mental health parity laws. 

The audit primarily covered claims made from Jan. 1, 2015 to March 31, 2016 and Jan. 1, 2017 to March 31, 2018, according to the report. The insurance department said some of the wrongly denied claims were handled by behavioral health vendors before Geisinger brought that process in-house in 2019. Geisinger also hired an outside consultant in 2019 to ensure mental health parity. 

Geisinger Health Plan said in a statement it is in the process of identifying next steps with the insurance department, but "many of the issues identified during the examination have long been addressed or corrected."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months