North Carolina has just fined UnitedHealthcare $3.4 million after a four-year investigation into balance billing violations. The state Department of Insurance found that UnitedHealthcare significantly mishandled grievances and claims for out-of-network anesthesia and emergency room services.
The company didn’t follow its procedures to negotiate with providers and protect members from balance billing. This occurs when an out-of-network provider charges more than the insurer allows and bills the patient for the difference.
The investigation also found UnitedHealthcare didn’t intervene to protect members. Some denial letters stated, “You are responsible for all costs related to this service,” or “You may be responsible for paying the difference between what the facility or provider billed and what was paid.”
“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,” NC Insurance Commissioner Mike Causey said in a press release. “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.”
UnitedHealthcare must now submit a corrective action plan and comply with future examinations. While the company accepted the settlement, it denied violating any laws.
The $3.4 million fine will be allocated to NC public schools. The investigation began after the Consumer Services Division identified a pattern of complaints about excessive cost-sharing beyond deductibles, copayments, and coinsurance.
