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Nebraska regulators accuse United HealthCare of hundreds of violations

Nebraska regulators accuse United HealthCare of hundreds of violations

United HealthGroup's troubles with Nebraska consumers continued last year, but the state's insurance regulator says the company's service and responses are improving.

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What’s happened:   The Nebraska Department of Insurance accused United Health Group of hundreds of violations of state insurance laws.  State examiners have met with United officials, who said they would fix the problems, the department said.

What did they do:  Complaints continued last year, the department said, about claims for chiropractic treatments, mental health, newborn baby care, gastric bypasses and other medical procedures.

Among United’s failures, as cited by the department, were delays in claims decisions, incorrect decisions about coverage and bad information given to consumers.

Among other violations alleged in a petition by the department, United failed to let policyholders know they could appeal its claims decisions to the state regulators.

The department also said United didn’t turn over accurate or timely information to the state, didn’t have an adequate network of emergency services or mental health and substance abuse treatment in rural areas and didn’t provide current lists of its care providers.

What’s next:  A state hearing on a departments petition describing the violations was scheduled for Feb. 14 but has been delayed by legal procedures until June.

What could happen:  The department's petition does not propose a specific administrative fine.

United HealthCare Group’s troubles with Nebraska customers continue, but the state’s insurance regulator says the company’s responses and service are improving.

The Nebraska Insurance Department said the company violated 18 Nebraska insurance laws more than 800 times during a review period, July 1, 2003 through June 30, 2004, and some complaints from customers continued through last year.

United HealthGroup companies cover about a quarter million Nebraskans with health insurance or health maintenance organizations. United has the second largest proportion of health insurance in the state, behind Blue Cross and Blue Shield, according to 2004 data.

The department has been dealing with service and claims problems with the company for years, and began imposing fines on the company in late 2003 and early 2004.    When complaints persisted, the agency levied a $62,500 fine in 2004 and began an investigation of the company's claims-paying practices.  

The company paid that and another $10,000 fine in 2005. 

In a story published by the Journal Star in May of last year,  State Insurance Commissioner Tim Wagner said complaints against United HealthCare had decreased.  United is trying hard to improve and has done so, in part because of the department’s attention, Wagner said this week.

But the improvements do not remove past violations, he said.

A spokesman for United HealthCare in Minneapolis said the company is taking the complaints seriously.

“We have cooperated fully with regulatory agencies’ examinations and reviews and consistently strive for effective solutions to improve service and monitor our own performance,” said spokesman Gary Thompson in Chicago.

Dr. David Filipi,  chairman of the Nebraska Medical Association’s Committee on Health Insurance, said he thinks United has been “struggling” to be a nationial insurer and has developed an operations blueprint to serve all states, when, in fact, each state regulates insurance on its own.

In trying to streamline a national business operation, they’ve failed to meet Nebraska’s legal requirements, he said, probably because it’s not as big a part of their market, as larger states.

“I think they’d have have been  far better served with a local presence handling appeals and claims processes, housed within in nebraska,” Filipi said.

In addition, Filipi said he’s seeing United being slow to deliver on promises to change claims procedures and pay new benefits.

“Some doctors suspect that’s by design,” Filipi said.  “ If it’s a promise, they need to deliver on it.”

Journal Star reporter Richard Piersol and the Associated Press contributed to this report.


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