United Healthcare Fined For Denying Claims For Chiropractic Treatment
The Missouri Department of Insurance conducted a market conduct examination of United Healthcare after patients and chiropractors filed complaints about the company improperly denying claims. The Department of Insurance found United Healthcare violated state insurance laws by failing to evaluate the medical necessity of treatment before denying claims. Pursuant to a settlement with the Missouri Department of Insurance, United Healthcare has agreed to reexamine at least 50,000 claims filed since 2004 by chiropractors who treated the company’s policyholders and will pay $536,000 in fines.
“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. “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 would be entitled to reimbursement directly from United Healthcare.
Update: Two class action were recently filed by chiropractors against insurance companies that have tried to recover what they believe were unwarranted payments. The first suit, filed in New Jersey Federal Court by five practitioners and three state associations, charges that Aetna made improper repayment demands and that its post-payment audit process violates the federal Employee Retirement Income Security Act (“ERISA”). The class action also claims that certain Aetna clinical policy bulletins misclassify chiropractically accepted procedures as experimental and investigational. The second class action, filed in Chicago by 15 practitioners and their state associations, accuses the BlueCross BlueShield Association and a number of its state-based licensees of similar wrongdoing.
If you are a chiropractor or a consumer with health insurance coverage, and believe that your chiropractic claim was denied improperly, please contact us to discuss your legal options.
That was just right. They must be fined for doing that. It is unfair to the client. They just wanted to be treated but United Healthcare does not give it to them. They must be punished for doing that.
Nowadays, it has become quite common that many health care firms are being penalized for denying various claims for different medical treatments.