RALEIGH — North Carolina is fining UnitedHealthcare $3.4 million for violations over claims that the group didn’t protect members from “balance billing.”
North Carolina Insurance Commissioner Mike Causey made the announcement on Friday. The fine comes after a four-year investigation into UnitedHealthcare’s handling of member grievances and claims processes involving out-of-network providers, particularly for anesthesia and emergency room services.
“Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and make sure all providers attending them are in-network,” Commissioner Causey said.
Causey says UnitedHealthcare didn’t consistently follow its procedures to negotiate with providers to protect members from balance billing. 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.
UnitedHealthcare says it accepted the final report and settlement, but the group denied violating any statutes, rules, or regulations. UnitedHealthcare agreed to provide a corrective action plan to address the violations, and they’ll be examined in the future.
The $3.4 million fine will go to public schools in the state.
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