UPMC health coverage fined for claim denials, slow processing

Local News

HARRISBURG, Pa. (WKBN) – A state audit under the Affordable Care Act found that UPMC health coverage committed several violations.

From Jan 2015 to March 2016, the audit found several claims processing violations including claims being denied when they should have been paid and notification and processing delays.

The examination also reported Unfair Insurance Practices Act violations relating to unclear communications, as well as prompt pay and interest violations, and maximum-out-of-pocket miscalculations. It also found violations relating to mental health claims.

UPMC was fined $250,000 and ordered to take corrective action and reprocess claims, including any interest. They must also improve their system for maximum out-of-pocket calculations.

The UPMC ACA examination was the fifth completed by the department. The other companies issued consent orders were:

•           Blue Cross of Northeastern Pennsylvania into Highmark, Inc.
•           Aetna Inc.
•           UnitedHealthcare Insurance Company
•           Independence Health Group

A full copy of the UPMC Health Coverage, Inc. and UPMC Health Options, Inc. examination report may be found here.

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Mel Robbins Main Area Middle

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