UnitedHealthcare will pay $150k over unlawful referral requirements

UnitedHealthcare has inked a settlement with the Missouri Department of Insurance, resolving allegations that the Minnetonka, Minn.-based insurer unlawfully required members to get physician referrals before receiving treatment from other in-network providers.

Under the agreement, UnitedHealthcare will pay a $150,000 fine, cease referral requirements on non-HMO group policies by October and move small and large group business plans to non-HMO plans without referral requirements. The settlement also requires UnitedHealthcare's affiliate, All Savers Insurance, to pay claims that were denied because referrals were not obtained.   

In addition, the department alleged UnitedHealthcare made false statements during the investigation by providing two call recording transcripts from an unrelated member complaint. Under the agreement, the insurer will write policies and procedures to ensure future information given to the department is complete. UnitedHealthcare will also save all recordings regarding claims for three years and supply recordings to the department when asked. 

More articles about payer issues:
Providence Health Plan drops 11,000 members
BCBS of North Dakota launches Blue Alliance pay-for-performance program
Alabama physicians prepare for Medicaid cuts

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