Missouri Settles with Major Health Insurer over Claim Denials

Missouri insurance regulators announced a million-dollar settlement with a major health insurer over alleged violations that include denying childhood immunization and cancer screening claims.

The Missouri Department of Insurance settled with Time Insurance Co., Union Security Insurance Co. and John Alden Life Insurance Co.

State insurance regulators allege that the three health insurance companies that issue policies for Assurant Health violated Missouri law in how claims were being handled.

According to the DOI, market conduct examination into the three companies found several instances where the companies denied claims for childhood immunizations, colon cancer screenings, mammograms, Pap smears and prostate screenings. In some cases, claim payments were denied or reduced because the companies imposed waiting periods, copayments or deductibles for these preventive care procedures, the department said.

Under the settlement agreement, the three companies will:

• Agree to provide childhood immunizations to Missouri residents without copayments, coinsurance, deductibles or waiting periods.
• Review all denied claims for childhood immunizations, colon cancer screenings, mammograms, Pap smears, prostate screenings and paid claims for short-term major medical submitted to each company since Jan. 1, 2004.
• Pay those claims that should have been paid along with interest at a rate prescribed by law.
• Modify their processes to comply with state law in the future.
• Pay a $500,000 fine to the Missouri State School Fund.
• Donate $500,000 to a Missouri charitable or nonprofit organization or organizations selected by the companies and approved by the department.

Source: Missouri Department of Insurance

Topics Carriers Claims Missouri