One of four major health insurers the Washington state insurance commissioner's office is investigating for allegedly failing to pay valid emergency room claims has agreed to settle.
QualMed Washington Health Plan agreed Aug. 19 to pay a $250,000 fine, cover all valid claims during the period under investigation and take steps to prevent the problem, according to a written statement by Deborah Senn, insurance commissioner.
QualMed is a Bellevue, Wash.-based subsidiary of Foundation Health Systems, Woodland Hills, Calif. The three other plans under investigation are Aetna U.S. Healthcare, Premera Blue Cross and Regence Blue Shield. Negotiations continue with all three, said a spokeswoman for Senn.
The investigation stems from an insurance department review of nearly 750 denials of emergency room coverage by the insurers in 1998 (March 29, p. 40).