UnitedHealthcare promises reform in deal with state regulators

The insurer agreed to pay millions of dollars and improve how it works with doctors. But physicians aren't sure if things will get better.

By Emily Berry, AMNews staff. Oct. 1, 2007.

UnitedHealthcare is paying $12 million, and promising to improve its claims payment procedures and physician communication, under the terms of the first-ever multistate settlement between a health plan and insurance regulators. It closes a three-year investigation into the company's payment practices.

The agreement between United and 36 states and the District of Columbia includes specific penalties if United does not meet minimums for claims accuracy -- 96% in 2008, and 97% in 2009 and 2010 -- and is the subject of too many physician and patient complaints.

While physicians will receive none of the $12 million, which goes to state insurance departments, they might receive some back payment for claims, plus interest, that the insurance regulators or the company discovered to be "erroneous." Claims no more than three years old are eligible.

But much of the agreement includes general goals with little outline on how exactly they would be reached, and how physicians would benefit, say organized medicine representatives. For example, the settlement agreement doesn't say exactly how much in back claims will be paid, or what the interest rate would be.

American Medical Association President Ronald M. Davis, MD, a preventive medicine specialist from East Lansing, Mich., said the Association is requesting "clarification and guidance" from state insurance commissioners on "how the settlement terms will be interpreted and enforced for the benefit of the physicians and their patients."