RALEIGH, NC – North Carolina Insurance Commissioner Mike Causey fined UnitedHealthcare of North Carolina Inc. and its affiliate UnitedHealthcare Insurance Co. $3.4 million on Friday, following over four years investigating the companies’ claims handling practices involving balance billing.
In addition to the fine, UnitedHealthcare agreed to provide the Department of Insurance with a corrective action plan to address violations uncovered in the investigation and submit to future compliance examinations.
The investigation targeted UnitedHealthcare’s handling of member grievances and claims processes involving non-contracted or out-of-network providers and facilities for anesthesia services and emergency room services to see if it was following its procedures to protect members from balance billing and complying with North Carolina law. Balance billing occurs when an out-of-network provider charges more than the insurer allows for an in-network service and tries to collect the excess cost from the member. The investigation found instances where UnitedHealthcare did not follow its own procedures to negotiate with providers to hold the member harmless…