Missouri Fines United Healthcare Over Chiropractor Claims Handling

August 27, 2009

The Missouri Department of Insurance says 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.

Source: Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP)

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