RALEIGH – North Carolina Insurance Commissioner Mike Causey announced last week that the state’s Department of Insurance has entered into a voluntary settlement agreement with Humana Insurance Co. that includes a $ 630,000 penalty for numerous violations related to health insurance.
“Health insurance policyholders need to know what is covered and not covered by their policies,” Causey said in a Thursday statement announcing the settlement. “I expect health insurers to do the right thing when it comes to paying claims. “
According to the NCDOI, the violations are related to the treatment of insureds, claims practices, failure to inform providers of decisions in a timely manner, and failure to use North Carolina licensed physicians in the process. call.
Offenses include the following: subjecting members to non-network costs where network health care providers were not readily available, imposing cost-sharing for emergency services different from what would have been imposed with a network provider and not pay for emergency services in which a reasonable person might believe a delay would be detrimental.
In addition to the penalty of $ 630,000, which goes to public schools as required by state law, Humana has agreed to pay members $ 227,205.94 at the request of the commissioner and NCDOI.
Humana has accepted the Voluntary Settlement Agreement without admitting any liability or violation of any federal or state laws, regulations or rules.
In addition to paying penalties and payments to consumers, Humana provided NCDOI with a corrective action plan for the future.
Humana no longer operates in North Carolina. She left the group health insurance market for small employers as of December 31, 2014, and the major individual medical market as of December 31, 2016.