In a significant regulatory action, North Carolina Insurance Commissioner Mike Causey has imposed a $3.4 million fine on UnitedHealthcare of North Carolina Inc. and its affiliate, UnitedHealthcare Insurance Co. This penalty follows a comprehensive four-year investigation into the company’s claims handling practices, particularly concerning balance billing violations.
Balance billing occurs when out-of-network healthcare providers charge patients the difference between their fees and the amount covered by insurance, often leading to unexpected and substantial medical bills for patients. The North Carolina Department of Insurance’s investigation revealed that UnitedHealthcare failed to protect members from these unforeseen out-of-network charges, especially in emergency room and anesthesia services. The probe identified instances where the insurer did not adhere to its own procedures to negotiate with providers, thereby not shielding members from excessive financial burdens.
Commissioner Causey emphasized the undue stress such practices place on patients, stating, “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.” He further noted that UnitedHealthcare’s actions “potentially put unnecessary financial burdens on many North Carolinians.”
In response to the findings, UnitedHealthcare has agreed to submit a corrective action plan to the Department of Insurance and will undergo future compliance examinations to ensure adherence to state regulations. While the company accepted the final report and settlement agreement, it expressly denied any violations of statutes, rules, or regulations. A company representative stated, “We are committed to protecting our members from out-of-network care providers who bill excessive fees, particularly in acute or urgent settings.”
The $3.4 million fine will be allocated to benefit public schools in North Carolina, as mandated by the state’s constitution. This action underscores the Department of Insurance’s dedication to safeguarding consumers from improper billing practices and ensuring that insurers comply with established protocols to protect patients from undue financial hardship.
Sources:
- North Carolina Department of Insurance Press Release
- WRAL News
- Star Tribune
- WCNC News
- Winston-Salem Chronicle
