United Healthcare fined

By CARLY FARRELL

AMERICUS — United Healthcare (UHC) and sister companies United Healthcare of Georgia Inc. and Golden Rule Insurance Co., new provider of state employees’ health insurance as of Jan. 1, has been fined $2.8 million by John W. Oxendine, insurance and fire safety commissioner of Georgia.

“UHC and its affiliates of Georgia have had a terrible record of paying claims on time,” Oxendine said on Tuesday afternoon.

The fine comes after an examination was done by the Georgia insurance department which found that UHC was late with between 75,000 and 80,000 claims in accordance with Georgia’s law that requires prompt payment. The inquiry into UHC’s claims came after numerous complaints about the insurance company. Georgia’s prompt payment law requires that a claim must be paid within 15 business days, or explain to their customer why there is such a delay.

UHC was also fined by Oxendine for similar delinquencies in 2000 and 2002.

Oxedine said that $2.3 millionhad already been paid by UHC to the office without going to court, but the other half-million dollars has been temporarily probated.

“I rescinded the $500,000 on the contingency that they’ll reform their company,” Oxendine said. Oxendine explained that his office and UHC have come to an agreement; UHC is currently on probation by Oxendine’s office, and Oxendine’s office is hoping that UHC will reform their policies. Since UHC and Oxendine’s office came to the agreement out of court, UHC waived its right to a hearing. “If they fulfill certain reforms and fulfill terms probation we will rescind a half million dollars, but they if they don’t, we’ll file corrective action,” Oxendine said.

This time, though, is different from the times UHC has been fined in the past; Oxendine provided the company with new computer systems to help their billing inquiries.

“I don’t just want to throw the company out because that’s bad for competition. But, we’re hoping this fine will evoke changes in their company.” If the company does receive, over the next year, the extent of the probationary period, numerous complaints about the company from its customers, Oxendine’s office has the right to take UHC to court, and potentially has the power to revoke UHC’s license all together. However, if UHC has no complaints over the next year, the half a million dollars will be absolved.

In reference to the governor’s switch to UHC for the state employees’ plan, “ ... we didn’t choose the state insurance provider; we were not asked, but we should have been.” Oxendine said that he would have given the governor’s office the shady history of UHC if he had been asked.

Moreover, according to Peggy Nielson, Sumter County’s state school board representative, “This past December, the University of Alabama/Birmingham Healthcare System terminated its contract with United Healthcare for significant issues of non-performance. Now it has learned that University Health Systems of Eastern Carolina has also terminated its contract with United Healthcare. Both these systems are huge hospital and clinic providers in Alabama and North Carolina. The North Carolina Medical Association has sued United Healthcare for unfair trade practices, including unlawful delay of payment and unilateral reduction of fees without provider input or notification.”

Nielson also said that although most southwestern Georgia’s coverage has been resolved with UHC, there still stands an issue with the coverage networks. Although many hospitals and doctors have signed with UHC, there’s still an issue as to whether the hospital and/or doctors’ offices will be in or out of network coverage. Nielson suggested to “ ... be sure that your provider has the most current State Health Benefit Plan UHC contract.”

Nielson suggested that since the legislation gets underway again this month, worried parties should contact their constituents with their concerns.

Nielson also said that although there is a good coverage base in South Georgia now, DeKalb and Gwinett counties still are undercovered by UHC.

State Sen. George Hooks, D-Americus, in reference to the issue, said, “This is not just a local issue — it’s a state wide problem in that the state of Georgia chose to go with a company gaps in its network. I am relieved that the hard work and team effort on a local level was able to close many gaps. However, there are problems that continue to exist throughout the state of Georgia. It’s the first thing I intend to peruse this week in the budget meetings prior to the session (beginning) to ensure that our state is taken (care of.) You may rest assured that I will be on front line throughout the session battling for policy holders.”

State Rep. Mike Cheokas, D-Americus, said, “I’m not sure what’s going to happen when I get to Atlanta next week, but (UHC has been) a disaster in South Georgia. The mail and the phone calls from my constituents — they’re concerned —they weren’t mad — they were frightened because of the potential drive to Macon or Columbus.” Cheokas went on to say that he’d like to wait until the session begins to see what proposals come before the Legislature before making a comment about UHC in more detail.

Local family practitioner who also is a specialist in sports medicine, Dr. Michael Busman, said that he has not had a problem with UHC’s state benefits yet because Tuesday was the first full day of working since the new year began.

But he said he’s still weary of the insurance group. “I don’t like them; they were fined by several states for late payments.” Busman said that if UHC was ever to drag its heels in paying a claim to one of his patients, he would report them to Oxendine’s office.

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