The North Carolina Department of Insurance (NCDOI) has entered into a voluntary settlement agreement with Humana Insurance, which includes a $630,000 fine that the insurer must pay for health insurance violations.
According to an official release from the NCDOI, the violations are related to policyholder treatment and claims practices. They include subjecting members to out-of-network costs when in-network healthcare providers were not readily available, imposing cost-sharing for emergency services different from what would have been imposed with an in-network provider, and failing to pay for emergency services in a timely manner in situations wherein a delay would be harmful.
Humana was also penalized for failing to timely notify providers of policy-related decisions, and failing to use North Carolina licensed medical doctors in the appeals process.
“Health insurance policyholders need to know what is covered and not covered under their policies,” said NC Insurance Commissioner Mike Causey. “I expect health insurers to do the right thing when it comes to paying claims.”
On top of the $630,000 penalty – which will go to public schools as required by NC law – Humana has agreed to pay $227,205.94 to its NC members at the request of the state insurance commissioner and NCDOI.
Humana accepted the voluntary settlement agreement without admitting any liability or violation of federal and/or state laws. The insurer has also provided the NCDOI with a corrective action plan as part of the deal.
The NCDOI noted that Humana no longer operates in the state, having exited the small employer group health insurance market effective December 31, 2014, and the individual major medical market effective December 31, 2016.
