Class Action Blog : Consumer Fraud, Consumer Protection, Securities and Antitrust Lawyer & Attorney : Meiselman, Denlea, Packman, Carton & Eberz

A civil lawsuit has been filed against Central United Life Insurance Company (“Central United”) alleging that the company illegally changed the terms of its cancer insurance policies in order to avoid paying thousands of dollars due to its policyholders who get treatment for cancer.  Central United sold insurance contracts known as “specified disease” policies which promised to pay policyholders the amount charged to them for their medical care if they are diagnosed with cancer, even if their treatment is actually paid for by health insurance.

The lawsuit, filed by the Missouri Department of Insurance, alleges that Central United changed its claims-handling practices to drastically reduce payments to policyholders with cancer.  It is alleged that Central United decided to pay policyholders based on treatment costs, rather than actual damages.  For example, when consumers with health insurance receive medical treatment, insurance companies pay a negotiated rate, which is less than the rate billed to the consumer.  Central United allegedly reimbursed its policyholders who got cancer the lower negotiated rate -- not the actual rate billed to the consumer -- thereby shortchanging its policyholders of thousands of dollars on their medical claims and saving itself thousands, if not millions, of dollars.

“The very essence of insurance is providing protection when life-changing events occur,” said John M. Huff, Missouri Department of Insurance, Financial Institutions and Professional Registration, commenting on the civil lawsuit filed against Central United.  “There are few events more life-changing than cancer, and this arbitrary decision by Central United is an attempt to abandon its solemn responsibility to protect its policyholders facing a serious and sometimes deadly disease.”

If you are a consumer who purchased a Central United cancer policy, please contact us to discuss your legal options.

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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.

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