Posts Tagged - ‘health insurance claims’

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Will Health Insurance Plan Provider Pay $10 Billion Fine?

Thursday, September 9th, 2010

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.

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Don’t Delay Filing Out-Of-Network Health Insurance Claims

Monday, July 12th, 2010

Image: anomalous4 under CC 3.0

Some health insurance plans–especially high-deductible ones such as health savings accounts–allow patients to go outside of their provider networks to utilize the doctors and hospitals of their choice. Normally, this costs more to consumers; however, the increased freedom is nearly priceless to some.

In most cases, your health insurance will cover at least a portion of the cost of out-of-network care. Unfortunately, you are responsible for submitting the claim paperwork yourself. Check your policy for information about deadlines–if you miss the timely filing limit, you may end up having to pay the whole bill out-of-pocket!

While it’s usually possible to file a dispute or appeal with your insurer, doing so can have a negative impact on your credit rating.

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