August 25, 2009
Missouri Department of Insurance fines United Healthcare; insurer to review 50,000 claims for chiropractic treatment
Jefferson City, Mo. – Two subsidiaries of United Healthcare, based in St. Louis, will pay $536,000 in fines and reopen chiropractic claim files it denied since 2004. Under a settlement with the Missouri Department of Insurance, United Healthcare has agreed to reexamine at least 50,000 claims filed by chiropractors who treated the company’s policyholders. The Department of Insurance found United Healthcare violated state insurance laws by limiting coverage to 26 visits per year. In other cases, the department says the company failed to evaluate the medical necessity of treatment before denying claims.
“When Missourians entrust their health coverage to an insurance company, they expect and deserve to be treated fairly and legally. We have taken this action to make sure that happens,” said John M. Huff, Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). “We believe the review of these 50,000 files may determine money is due to other providers and possibly consumers.”
For any chiropractic claims it finds were improperly denied, United Healthcare must reimburse the physicians for those claims, plus interest. In some cases, consumers may have paid the bills, rather than the chiropractors. Those consumers should contact United Healthcare at 800-873-4575. Patients or chiropractors with questions about the settlement can the Department of Insurance Consumer Hotline at 1-800-726-7390 or visit insurance.mo.gov.
The department conducted a market conduct examination of United Healthcare, after patients and chiropractors filed complaints about the company denying claims. A 2004 Missouri law requires health insurance companies to cover the costs of at least 26 chiropractic visits per year without prior authorization. For the first 26 visits, coverage can only be denied if the treatment is determined not to be medically necessary. The department’s exam reviewed United Healthcare chiropractic claims since the law took effect.
The department conducts 30 to 40 market conduct exams of insurance companies in a typical year, and in 2008 these exams yielded more than $6 million in restitution for consumers and more than $700,000 in fines to benefit Missouri public schools. The Department of Insurance can order a market conduct exam at any time if it suspects violations of Missouri insurance laws.
About the Missouri Department of Insurance, Financial Institutions & Professional Registration
The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) is responsible for consumer protection through the regulation of financial industries and professionals. The department’s seven divisions work to maintain consumer confidence by examining and monitoring industries and professions and by establishing coherent and evolving policies. DIFP works to enforce state regulations both efficiently and effectively while encouraging a competitive environment for industries and professions to ensure consumers have access to quality products.
For further information, contact: The Public Information Office at (573) 751-2562.