One of the many complexities associated with health care is the constant mergers and buyouts. The worst-case scenario is that when your health insurance plan is caught in the middle, your health falls by the wayside.
That’s what the state of California’s insurance commissioner accuses PacifiCare of doing after being acquired by United HealthCare several years ago. Former PPO patients state that their documents were lost or incorrectly entered into the system, causing their claims to be denied. This allegedly went on for several years, from 2006 (shortly after the merger) until 2008.
The insurer is unlikely to pay out the entire sum: it’s only the maximum they could be liable for, based on a fine of $100,000 per count for nearly a million counts. In the vast majority of cases, they will settle with the state.