Missouri insurance regulators resolve United Healthcare dispute

(Jefferson City, MO – Insurance News and Markets) – The Missouri Department of Insurance has reached an agreement with United Healthcare Insurance Company, All Savers Insurnace Company and United Healthcare Life Insurance Company following investigation of claims that the companies restricted access to medical providers by requiring referrals before an individual could get treatment from antoehr in-network doctor.

“Consumers should not have to incur the extra time, cost, delay and hassle of going through a ‘gatekeeper’ just to get access to t their very own doctor already in their very own network,” said Department of Insurance Director John M. Huff. “I applaud our market conduct team for working to stop this unnecessary delay of health care access for Missouri consumers.”

United Healthcare agreed to stop using referral requirements on claims from non-HMO group policies beginning in October 2016. It will also transition small and large group business to non-HMO products that do not have gatekeeper requirements.

The settlement agreement also provides that United Healthcare and its affiliated company All Savers Insurance Company will pay “direct access,” claims, that were improperly denied or reduced for lack of a referral.  Direct access claims are those claims for certain types of services or specialists, like gynecologists, where patients are not required to have referrals in order to access these services.

In the agreement, the department also alleges that United Healthcare made false entries in statements used in an investigation, by providing the department with transcripts of two call recordings relating to a member complaint that did not accurately reflect the content of the calls.

As part of the settlement United Healthcare paid a fine of $150,000.

Source: Missouri Department of Insurance.