Wednesday, January 30, 2008

United Health hit with $3.5 million fine

United Health has been hit with a $3.5 million dollar fine by the Department of Managed Health and it couldn't happen to a more deserving company! The department of Insurance investigated the company and found it had violated more than 130,000 claims and improperly denied 30% of claims that were reviewed during the investigation. That is not an accident. Underpaying or denying 130,000 claims is a company culture!

Here's one little example of what they do.

This after noon I received a letter from United Health regarding a patient I saw December 7, 2007. The charge was $115.00, submitted on the usual standard claim form with the proper codes and descriptors. Get this...instead of a payment for services rendered seven weeks ago, they are requesting the Doctor's name (!!!), title (!!!), and medical license number. Yes, I have been seeing United Health patients for years, but they are requesting, from Dr. Toni Brayer, my name. If this isn't the most blatant delay in payment I don't know what is.

David Hansen, regional CEO for United Health told the Wall Street Journal "We have already taken and continue to take aggressive steps to address the issues raised by the departments and to improve our operational performance in California." Gee, I guess someone forgot to tell the claims payment department that.


Dr. Know said...

Yes, you are so right. The insurance industry is so far ahead of us with their ability to use creative software to deny claims, bundle services and keep money that should be used for care.All you need to do is look at the earnings profiles to see where the money is going.

Healthnut said...

UH may be hit with a small fine, but they are going to come with other means to deny. Insurance companies already are becoming more selective as to who they take on as applicants and not everyone qualifies.

Toni Brayer MD said...

To healthnut: I agree and your comment is an understatement of the realities of insurance underwriting. If you have even a hint of a prior condition, no matter how minor (allergies, pink eye, breast cyst, menstrual cramps) you will be denied outright or be made to pay higher premiums. We need universal health coverage with regulations against cherry picking. That is how insurance and health care should work.

carymc said...

I have United, and they are abysmal. I always laugh at their payment denial codes, which are always three-digit numbers. That's a lot of different reasons to deny payment!

muebles mostoles said...

This will not succeed in reality, that is what I think.