The state’s Department of Insurance said that a four-year investigation into the insurer determined that UHC did not properly protect members from out-of-network charges, especially in emergency and anesthesia services.
The investigation further determined that UHC did not follow its own procedures, and did not negotiate properly.
Moreover, proper negotiations could have saved providers and patients money. The state began investigating UHC after receiving complaints from both members and providers.
The state alleged that members were wrongly faced with cost-sharing beyond standard deductibles, copayments and coinsurance for medically necessary services performed by out-of-network providers at in-network facilities, according to the report.