Following a thorough investigation that found the insurance provider had participated in unfair billing practices, the state of North Carolina fined UnitedHealthcare $3.4 million, resulting in severe penalties.
The investigation was led by Mike Causey, the Insurance Commissioner of North Carolina, and took four years to finish.
The practice of balance billing, which has a direct bearing on patients’ financial obligations and medical expenses, was the focus of the investigation.
When medical professionals bill patients for the difference between the amount their insurance company has authorized for a service and the actual cost incurred by the provider, this is known as balance billing.
The state concluded that UnitedHealthcare of North Carolina had frequently abused the process in this instance, particularly with regard to anesthesia and ER services rendered in non-contracted facilities.
The results of Commissioner Causey’s investigation showed that UnitedHealthcare did not interact with non-contracted providers in accordance with its own set protocols.
“Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and make sure all providers attending them are in-network,” Commissioner Causey stated. “UnitedHealthcare’s practices potentially put unnecessary financial burdens on many North Carolinians. I am happy to see that UnitedHealthcare has agreed to take corrective action.”
Due to this mistake, patients were forced to pay the “leftover balance” after being invoiced for items that were not included in their prearranged healthcare plan.
Numerous complaints from UnitedHealthcare members who expressed dissatisfaction about being required to pay more than what was specified in their insurance coverage exposed these inappropriate billing practices.
Members were required to pay cost-sharing amounts that were significantly higher than their deductible, copayment, and coinsurance obligations, according to the state’s analysis of these complaints.
Commissioner Causey concluded that UnitedHealthcare had engaged in unfair business practices and breached state laws pertaining to balance billing as a consequence of the investigation.
UnitedHealthcare of North Carolina was also obliged to provide the North Carolina Department of Insurance with a remedial action plan in addition to the substantial $3.4 million punishment.
Addressing the infractions and making sure that such problems don’t arise again are the goals of the action plan.
In order to make sure that its operations going forward comply with state laws, UnitedHealthcare has also committed to subject to continuous compliance reviews.
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According to Article IX, Section 7 of the North Carolina Constitution, the fine will be used to support the state’s public schools in compliance with state law.
This is an important finding from the investigation since the money gathered from the fine will assist public schools throughout the area and the state’s educational system.
This fine serves as a reminder of the significance of closely following insurance policies and the requirement that healthcare providers continue to be open and equitable in their billing procedures.
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It also draws attention to the persistent difficulties that patients have with medical billing, especially when interacting with providers and services that are not contracted.
The goal of this case’s settlement is to hold healthcare companies responsible for their activities while shielding customers from future instances of similar practices.
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