I chose to research health insurance corporations this week, looking for cases involving mishandling of patient claims. In the 17 years I’ve worked in Patient Finance, I’ve appealed hundreds of high dollar claims that should have been paid by the insurer.
In 2005, United Healthcare acquired Pacificare, and the transition did not go as planned. In an effort to save money, United Healthcare began denying claims for high cost, sometimes life-saving services provided to it’s members. In total, the California Department of Insurance found 908,000 violations against it’s insured members. UHC is looking at a minimum of $91 million in fines, with an additional $82 million in appeal. If the decisions are upheld, this case sets a precedent in protecting insured patients against cost saving tactics by health insurers.
Haefner, M. (n.d.). UnitedHealth faces $91M fine after California court’s fair claims decision: The California Court of Appeal upheld regulations for fair claims settlements after a 10-year legal challenge, paving the way for $91 million in fines against a UnitedHealthcare subsidiary, the California Department of Insurance said Sept. 21. Retrieved from https://www.beckershospitalreview.com/payer-issues/unitedhealth-faces-91m-fine-after-california-court-s-fair-claims-decision.html
https://www.cnn.com/2019/01/28/health/california-supreme-court-insurance-commissioner-decision/index.html