UnitedHealthcare Agrees to $800k Settlement in North Carolina for Insurance Violations

Posted on Aug 28, 2008
According to the Triangle Business Journal, UnitedHealthcare will pay fines totaling $786,656 in response to a number of alleged state regulation violations. These issues are related to the way that United Health processes claims, handled customer complaints, and other business matters. The fines will be distributed to North Carolina public schools as delineated in state law.

The North Carolina Insurance Department clarified that this insurance settlement is not associated with the high-profile 38-state agreement that was signed earlier in the year with the same insurance company. However, this newest settlement does cover many of the issues that were discussed in the multi-state settlement. North Carolina was not part of the larger statement because it placed restrictions on future regulatory investigations by insurance departments - a door that North Carolina did not want to close.

"We didn't want to be restricted in what we could check up on," explains Insurance Department spokesperson Chrissy Pearson.

This is the second time in five years that United Health has agreed to a monetary settlement with North Carolina due to their questionable practices regarding insurance claims, insurance claim response time, and customer service. In 2004, the insurance company paid out $2.2. million to settle systematic problems with the United Health's claims processing. In both cases, UnitedHealthcare is not admitting any violations of NC Department of Insurance policy or state law.

"Today's agreement provides a meaningful way to assess how we measure up to the high standards of service that people in North Carolina expect," the company said in a statement. "It also builds on the steps that UnitedHealthcare is taking in North Carolina as part of a broader, national effort to ensure the company provides access to high-quality, affordable health care and the best possible service."

Also in response to the settlement, the company is launching a "process improvement plan" that includes covering eight areas of its business and five areas of improvement. Specifically, the five areas of improvement are claims accuracy, claims timeliness, non-clinical appeals resolution, clinical appeals resolutions, and claims complaints that come through the Insurance Department itself.

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