PacifiCare Health Systems, Santa Ana, Calif., has been fined $125,000 by the Arizona Department of Insurance for more than 1,000 violations of state laws governing health plans. The violations, which occurred between January 1996 and December 1998, included failure to process claims on time, failure to inform members about insurance changes and their right to appeal coverage denials, and failure to protect the privacy of members whose disputed claims underwent external review. PacifiCare did not challenge the fine but said it had corrected the failures years ago and is now in compliance with the laws. In March 2001, the insurer was fined $250,000 by California's Department of Managed Health Care for failing to pay claims within the mandated 45 days. And in November 2000, the Texas Department of Insurance placed PacifiCare under administrative oversight because of concerns about late payments to physicians and other failures. The oversight was lifted last year after the insurer agreed to spend $135 million to upgrade its claims processing system. -- by Laura B. Benko
PacifiCare draws fine in Ariz. for 4-year-old woes
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