In Oregon, PacifiCare, a division of United Health, has been fined for denying claims without investigating whether the patient’s problem was covered by their policy.
“The consumer and business services’ insurance division found that PacifiCare Life Assurance had refused to pay for claims without first contacting enrollees or their health-care providers, Martinis said.”
“State officials also determined that PacifiCare failed to act promptly on claims and made enrollees with pre-existing medical conditions wait one year for coverage. Oregon law requires insurance companies to cover pre-existing conditions after a person has been enrolled in a health plan for six months.”
“As a result of the state’s investigation, PacifiCare Life Assurance performed an internal review and paid nearly 5,000 claims that it previously denied without first conducting an investigation.”
“The insurer also took corrective action and paid more than 2,000 claims to which it had applied a 12-month pre-existing conditions provision.”
Medicynical Note: This company insures only 13,000 people in Oregon. They apparently denied 7,000 claims from this small population. Does anyone believe that these practices are limited? Are limited only to Oregon? Only to this division of UnitedHealth?
Private insurers are not there to provide coverage for or access to quality health care, they are in it for the money. The sooner we understand that the fiduciary responsibility of these companies is not to do good, the sooner we will be able to have a better, more responsive, possibly less expensive health care system.
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Anyone like me who can go only through the state high risk pool to get any health coverage worth paying (exorbitant) rates for is already aware of this fact. Health insurance companies exist to delay and deny – no matter whether you’re the insured or the provider.
Large employers that ‘self insure’ so employees can’t seek remedies through state insurance regulatory bodies are also evil, IMHO.
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