Pa. Insurance Department finds violations in UPMC’s health coverage/options procedures


HARRISBURG, Pa. (WHTM) — After conducting an examination into the practices and procedures of UPMC Health Coverage, Inc. and UPMC Health Options, Inc. the Pennsylvania Insurance Department found a series of violations and has announced a $250,000 penalty.

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“Protecting consumers and holding businesses to the highest standards remains the Insurance Department’s top priority,” said Insurance Commissioner Jessica Altman in a Pennsylvania Insurance Department press release. “We work to ensure that consumers are afforded all the rights and protections guaranteed to them by Pennsylvania law, and these market conduct examinations are a useful tool in that effort.”

The examination covers the period from Jan. 1, 2015, to March 31, 2016. It has identified claims processing violations, including claims being denied when they should have been paid and notification and processing delays. Additionally, it found Unfair Insurance Practices Act violations.

According to the press release, the department has ordered UPMC to take corrective action to address the violations. Claims that were incorrectly processed must be reprocessed and accurately paid with applicable interest, plus a series of other internal adjustments are also mandated.

“UPMC has been extremely cooperative and thorough in its response to examiner findings,” Altman said.

A reexamination process will take place in the future to ensure that the corrective actions and system improvements are completed.

To see a full copy of the examination report, click here.

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