UnitedHealthcare Insurance Co. agreed to pay a $3.4mn fine to the North Carolina Department of Insurance for balance billing practices that violate state law.
Balance billing occurs when a policyholder is charged for the portion of a medical bill not covered by insurance. This often happens when an out-of-network provider bills more than what an insurer allows for the same service in-network.
A four-year investigation by the insurance department reviewed UnitedHealthcare’s handling of claims involving noncontracted and out-of-network providers, particularly for anesthesia and emergency room services.
These services were often provided alongside in-network care. The regulator emphasized that a lack of in-network providers should not change a policyholder’s benefits or an insurer’s obligations.
The investigation also found UnitedHealthcare did not follow its own procedures to negotiate with providers, failing to prevent unnecessary financial burdens on policyholders.
Patients receiving emergency room services don’t have the time or ability to ensure all providers treating them are in-network. UnitedHealthcare’s practices may have placed an undue financial strain on many North Carolinians
Insurance Commissioner Mike Causey
Policyholder complaints revealed that the company often upheld balance billing decisions without intervening to reduce billing discrepancies. In some cases, policyholders received letters stating, “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.”
Beyond the penalty, UnitedHealthcare must submit a corrective action plan to address the violations. The company did not admit wrongdoing or accept the insurance department’s findings but agreed to the penalty.
