Health Plan To Correct Inaccurate Physician Directories

Attorney General Spitzer today announced a settlement that will require United Healthcare to stop providing misleading information to its policyholders and to provide restitution to consumers.

"Consumers should not be saddled with improper bills when they rely on health plan directories to choose their doctors," said Spitzer. "Health plans must accurately list participating providers so that patients can maximize their coverage and keep their costs as low as possible."

The case began when the Attorney General’s Health Care Bureau received a complaint from a consumer who had received services from a doctor erroneously listed as participating in United Healthcare’s (United) Empire Plan network. Because United then processed the consumer’s claim as one for out-of-network services, she had to pay the difference between the amount the doctor billed and the amount United paid, a much higher sum than the co-pay she would have paid for an in-network, participating doctor.

An investigation revealed that United erroneously listed certain doctors as participating in the Empire Plan at certain locations. The Empire Plan provides health coverage for more than one million active and retired state and local government employees and their dependents. The New York State Department of Civil Service relied on this erroneous information in its written and online directories of providers for Empire Plan members. These errors, which United attributed to computer programming problems, first occurred in 2000 and were included in its published directories until October 2005. The errors were corrected in the online directory in May 2004.

In addition to correcting the errors in its directories, United agreed to review Empire Plan claims back to January 2000 to identify all claims that were improperly processed and reimburse all members who incurred costs higher than the co-pay for in-network care.

United further agreed to pay $20,000 in penalties and $25,000 in costs. United cooperated fully with the Attorney General’s investigation.

This is the most recent in a series of cases brought under Attorney General's Spitzer’s "Clean Bills of Health" initiative, which focuses on improper billing of health plan enrollees by insurers and providers.

Over the past three years, the Attorney General’s Health Care Bureau has engaged in a series of investigations into balance billing by health care entities, including HMOs, hospitals, ambulance companies and diagnostic testing labs. In addition to today’s settlement, the initiative has resulted in settlements with MDS Labs and Quest Diagnostics (two major providers of diagnostic testing services), WellCare of New York and Empire Blue Cross (two New York health plans), Vineall Ambulance (an upstate ambulance company), Beth Israel Medical Center, The New York Presbyterian Hospital, and Albany Medical Center.

Consumers and providers with questions or concerns about health care matters may call the Attorney General’s Health Care Bureau Hotline at 1-800-771-7755 (option 3).

The case was handled by Assistant Attorney General Susan Kirchheimer under the supervision of Troy Oechsner, Deputy Chief of the Health Care Bureau and Joe Baker, Bureau Chief.


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