Today's L.A. Times carries Lisa Girion's story about investigations of Pacificare by California's state Department of Insurance and Department of Managed Health Care. Significant problems with untimely claims processing and improper claim denials arose after Pacificare was purchased by UnitedHealth Group two years ago. According to the story, the regulators plan to announce today fines of up to $1.33 billion by the Department of Insurance and $3.5 million by the Department of Managed Health Care.
Pacificare and UHG are going to try to negotiate to pay substantially less than the potential exposure they face for the fines. The insurer said the delays were mostly administrative and did not affect the quality of service insureds received. But that's difficult to swallow. Waiting to receive insurance coverage when you are dealing with health problems is one of the most financially difficult, emotionally stressful, and potentially life threatening situations a person can face.