Wis. Commissioner Announces UnitedHealthcare Settlement

Wis. Commissioner of Insurance, Jorge Gomez, announced this week that the UnitedHealthcare Group of companies has entered into an agreement with his office to correct market conduct and customer service issues. The settlement agreement requires the group to implement a corrective action plan and a compliance program.

UnitedHealthcare agreed to the settlement after the Office of the Commissioner of Insurance’s (OCI) investigation alleged that in 2004 and prior years, the company did not adequately respond to consumer complaints and grievances, notify insureds of, or process requests for, independent review of denied claims, and correctly pay for certain benefits.

“Consumers and providers need assurances that their health plan will fulfill service obligations. I am confident that the residents of Wisconsin will be protected under the agreement,” Gomez noted. “UnitedHealthcare has implemented a compliance plan that will ensure each customer receives service that meets or exceeds provisions required under Wisconsin insurance regulations. My department will oversee UnitedHealthcare’s performance under this compliance program and ensure that Wisconsin residents receive quality service.”

As part of the agreement, UnitedHealthcare also agreed to pay a $600,000 forfeiture. The agreement applies to the following subsidiaries that operate in Wisconsin: UnitedHealthcare of Wisconsin, Midwest Security Life Insurance Company and Unimerica Insurance Company.

“This agreement involved extensive discussion between state regulators and representatives of UnitedHealthcare,” according to Gomez. “UnitedHealthcare has made a significant commitment to improve its customer service and has expended substantial resources to develop and implement a compliance plan to meet Wisconsin requirements.”

Source: Wisconsin Office of the Insurance Commissioner