Healthcare Business News

UnitedHealthcare will pay to settle claims questions

Posted: September 6, 2007 - 5:00 pm ET

UnitedHealthcare has agreed to pay up to $12 million to 37 states to settle insurance commissioners’ concerns over the company’s claims payment services.

Based on complaint data, some of the states in 2004 launched an analysis of UnitedHealthcare companies’ compliance with insurance regulations, according to the settlement agreement. The analysis, aided by the National Association of Insurance Commissioners, identified “areas of concern” involving claims handling and administrative practices.

In addition to the payment, which could grow to as much as $20 million if other states join, the agreement establishes a framework and calls for an independent monitor to evaluate the companies’ performance through 2010 in several areas. They include whether the companies investigate, pay and deny claims on time and correctly; address complaints quickly and thoroughly; and provide accurate explanation of benefits.

Arkansas, Connecticut, Florida, Iowa and New York took the lead in working toward a resolution with UnitedHealthcare. A news release from parent UnitedHealth Group said the agreement “affects substantially all of UnitedHealthcare’s commercial health plans.”

Kenneth Burdick, UnitedHealthcare’s chief executive officer, said in the release that the agreement “breaks new ground in how we can work with states across the country for the benefit of our members and business partners.”

The companies “neither admit nor deny the regulatory findings and desire to enter into this agreement in order to promote regulatory efficiency, to avoid disruption to insureds, enrollees, and vendors, and are willing and desirous to resolve all multistate areas of concerns,” according to the agreement. -- by Gregg Blesch

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