Pa. Insurance Department fines UnitedHealthCare for failing to cover mental health, substance abuse claims

The health insurer must pay restitution to policy holders in cases where claims were miscalculated.

  • Brett Sholtis/Transforming Health

(Harrisburg) — UnitedHealthCare Insurance is expected to pay an undetermined amount of money to policy holders after it miscalculated claims for mental health and addiction-related services, according to the state Insurance Department.

From January 2015 through March 2016, the insurer failed to meet mental health parity laws and prompt pay laws, the department said. A 2008 federal law requires health insurance plans to cover mental health and addiction services to the same extent it covers medical or surgical care.

The department also flagged concerns with how the company covered services for autism and substance use disorders. The examination was tied to employer-based policies or those purchased on the Affordable Care Act exchange.

UnitedHealthCare didn’t immediately respond to a request for comment.

United failed to accurately calculate peoples’ total out-of-pocket costs, delayed payment and delayed responses to complaints, said Insurance Commissioner Jessica Altman.

Some people will get restitution from the company, Altman said, though she’s not sure how many are owed money, or how much they’re expected to get.

“We will be looking at that and tracking that, but don’t have any numbers behind that right now,” she said.

UnitedHealthCare also agreed to spend $800,000 to educate people about the mental health and substance use disorder services their health insurer is required to cover.

It’s also expected to pay a $1 million civil penalty for the violations, money Altman said will go into the state’s general fund.

The insurance department noted that it has issued similar reports to Blue Cross of Northeast Pennsylvania in early 2018 and Aetna in early 2019.

Altman urged people who think their health plan is out of compliance to contact the department’s Bureau of Consumer Services.

 

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