The investigation focused on the insurer’s handling of member issues and claims processes involving non-contracted or out-of-network providers and facilities for anesthesia services and emergency room service, according to a Feb. 7 news release. Anesthesia and laboratory services were often performed alongside procedures and services provided at in-network facilities where a member received services from an out-of-network provider. Complaints from members said they were being subjected to costs above their deductible, copayment and coinsurance liabilities.
The final report detailed instances where UnitedHealthcare did not follow its own procedures to negotiate with providers.
In addition to the fine, UnitedHealthcare also agreed to provide the state with a corrective action plan to address violations. The company accepted the final report and settlement agreement, but it did not admit to the findings contained in the report and denied violating any statutes, rules or regulations.
