Oregon Fines Health Insurer for Claims Denials
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[January 01, 2009]

Oregon Fines Health Insurer for Claims Denials

(BestWire Services Via Acquire Media NewsEdge) The Oregon Department of Consumer and Business Services has fined PacifiCare Life Assurance $46,000 for improperly denying nearly 5,000 legitimate health claims over three years.

The department?s Insurance Division began an investigation after a woman complained that PacifiCare refused to cover six of her seven medical claims, Director Cory Streisinger said in a statement.

The investigation found that PacifiCare was denying claims without contacting the people who made the claims or their health care providers to determine whether the services were covered, Streisinger said.

?Oregon law requires insurers to conduct a reasonable investigation before refusing to pay claims, and that didn?t happen here,? Streisinger said.

PacifiCare, a member of UnitedHealth Group Inc. (NYSE: UNH), reviewed more than 10,000 claims it denied during a 21-month period beginning in September 2005 and determined that it should have paid 4,928 of them, he said. Those claims have been paid, Streisinger said.



PacifiCare insured nearly 13,000 Oregonians and earned $42 million in health premiums in Oregon in 2007, Streisinger said.

Earlier this month UnitedHealth Group settled, without paying a penalty, a civil lawsuit filed by the U.S. Securities and Exchange Commission that alleged the backdating of stock options by senior company executives (BestWire, Dec. 23, 2008).



PacifiCare Life Assurance currently has a Best?s Financial Strength Rating of A- (Excellent).

UnitedHealth Group stock was trading at $26.53 a share on the morning of Dec. 31, down 1.89% from its previous close.

(By Alyn Ackermann, senior associate editor, BestWeek: Alyn.Ackermann@ambest.com)

Copyright ? 2009 A.M. Best Company, Inc.

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