Washington state Insurance Commissioner Mike Kreidler has fined three Washington state health insurers for violating insurance laws and rules.
Kreidler fined UnitedHealthcare of Washington, Inc., $5,000 for not using its correct, legal name 297 times in 2018 on checks and on correspondence with policyholders and medical providers. It used three incorrect names: UnitedHealthcare of Washington, UnitedHealthCare Insurance Company and UnitedHealthcare Services, Inc. State law requires insurers to use their legal name as a transparency measure for consumers
Kreidler also fined Premera Blue Cross $100,000 and its sister company, LifeWise Health Plan of Washington, $50,000 for multiple violations in 2018 and 2019 related to how they handled pre-authorizations for treatment and policyholders’ appeals. The issues were discovered after consumers filed complaints with Kreidler’s office.
One consumer filed a complaint after his planned December 2018 back surgery had to be rescheduled because Premera failed to authorize the procedure in a timely manner. The delay resulted in the surgery being rescheduled for January 2019, after his deductible renewed and he had to pay more out of pocket than he would have on the original surgery date.
Kreidler’s review found that Premera delayed responding to more than 5,000 preauthorization requests, representing 3 percent of its 2018 total, causing 43 policyholders, including the original complainant, financial harm exceeding $47,000, which Premera refunded in August 2019.
Kreidler also determined LifeWise delayed responding to 447 preauthorization requests, representing 4 percent of its 2018 total. The delays caused seven policyholders financial harm exceeding $6,000, which it refunded in August 2019.
A second consumer filed a complaint that Premera failed to properly process her appeal of its decision to deny medically necessary treatment. The consumer has a rare disorder that requires lifelong, regular physical therapy to avoid further complications.
Kreidler’s review found that from January 2019 until September 2019, Premera and LifeWise sent more than 300 appeal forms to policyholders that contained inaccurate information about appeals timelines.
A third consumer filed a complaint after LifeWise denied a claim for out-of-state emergency treatment in August 2018.
This legal action is not related to the customer service issues that Premera and LifeWise customers have been experiencing since late December. Kreidler’s office and the state Health Benefit Exchange estimate that about 2,000 Washington consumers are affected. Kreidler encourages consumers who are experiencing problems with accessing their Premera or LifeWise benefits to file a complaint.
