Delaware’s Department of Insurance announces penalties totaling over $350,000 against Highmark for improper volunteer ambulance company claims reimbursements.
Insurance Commissioner Trinidad Navarro explains Highmark has been sending payments to patients for ambulance services instead of to the ambulance companies themselves.
“Highmark should have been paying directly to the volunteer ambulance companies as required by law, and unfortunately, they were not. Normally we can resolve some of these issues by making a couple of phone calls," he said.
The department has told Highmark to take corrective actions, and Navarro notes the fine is so high due to the sheer volume of violations by the insurance company, finding nearly 400 claims to have been illegally paid by Highmark to the patient.
He says it's unreasonable to assume patients would send that money to the ambulance companies, and the confusion caused a lack of funding for volunteer ambulances.
“Many folks have challenges with inflation and many work paycheck to paycheck, and when they receive a check from the insurance company written out to them in their name, they cash them," Navarro said.
He says unfortunately the $350,000 fine will be sent to the state’s General Fund, rather than the volunteer ambulance companies, but he hopes to change that in the future.
The investigation also found 89 instances of Highmark refusing to pay claims without conducting a reasonable investigation based upon all available information.
The improper claims rejections occurred in cases where patients presented symptoms at a physician’s office but required emergency care and were transported to a hospital.
