The Delaware Department of Insurance issued $450 thousand in penalties to United Healthcare, several for repeat offenses for the insurance giant.
The Department of Insurance oversees insurance providers to make sure they are following regulations like the Mental Health Parity and Addiction Equity Act. Mental Health Parity laws make sure carriers aren’t discriminating policy holders on the basis of mental illness or substance use.
The Department’s examination found violations of Mental Health Parity laws. UnitedHealthcare prevented policyholders from pursuing needed care because of excessive cost and time or limited access, according to the Department.
Delaware Insurance Commissioner Trinidad Navarro said UnitedHealthcare had an opportunity to correct its violations after an exam several years ago where the Department levied no fines.
“But we see time and time again some of the exact same issues,” Navarro said. “And these aren't numbers, they're people. And people unfortunately are mistreated, taken advantage of, unfortunately by the industry… It's like they're not learning or they're not taking the appropriate corrective actions to ensure that this is no longer happening.”
The examination also found UnitedHealthcare wasn’t adequately reimbursing policyholders and wasn’t compliant with arbitration and appeals.
Navarro said Department staff will continue to do examinations on insurance carriers in the state and could increase fines moving forward.
But Navarro hesitated to go into other ways the Department could address the violations.
“One of the things that we struggle with here in the state of Delaware is having enough competition in the health insurance market,” Navarro said. “And so we want to work – and I mean this – we want to work with the carriers to get it right.”
The report did come through with some positive findings. UnitedHealthcare was compliant in its management of Pharmacy Benefit Manager and third-party administrator relationships.
And Navarro added the provider did make improvements in other areas, but they weren’t substantial enough to bring its service into compliant territory.
Navarro noted he would rather not level these penalties.
“But at the end of the day, these are repeated violations or prohibited practices we've seen now for a couple years…” Navarro said. “And so it really comes down to fairness, and it comes down to protecting consumers and promoting equity. The results of this examination are disappointing because whenever we have an exam like this and whenever we level penalties, it also comes with a corrective action plan.”
If carriers and staff put that plan in place, Navarro said his department would not expect to see these repeat violations.
