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Texas Imposes $9.25 Million In Health Claim Prompt-Payment Fines

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NU Online News Service, Aug. 1, 5:44 p.m. – Texas Insurance Commissioner Jose Montemayor has negotiated an agreement that requires seven large health insurers and managed care companies to pay $9.25 million fines and millions of dollars in restitutions for violating the state prompt payment laws and regulations.

Texas requires health carriers operating in the state to pay clean claims within 45 days.

The Texas Department of Insurance says it gave the carriers affected by the fines “ample time” to reduce claims processing times.

“These insurance carriers failed to pay doctors and other providers on time, even after passage of legislation, the revision of this agency’s regulations and strong warnings by the department,” Montemayor said in a press release publicizing the agreement. “Their time and my patience has run out.”

In addition to violating the 45-day limit, many of the carriers failed to maintain accurate complaint regards or adequately monitor subcontractors, the Texas department says.

The parent companies of the carriers affected include Health Care Service Corp., Chicago, (the parent company Blue Cross and Blue Shield of Texas); CIGNA Corp., Hartford; Great-West Life & Annuity Insurance Company, Denver; Sierra Health Services Inc., Las Vegas; WellPoint Health Networks Inc., Thousand Oaks, Calif.; and UnitedHealth Group Inc., Minnetonka, Minn.

Aetna Inc., Hartford, and PacifiCare Health Systems Inc., Santa Ana, Calif., are “under TDI review,” the Texas department says

Texans for Lawsuit Reform, Houston, a group that has opposed efforts to help patients sue health plans, put out a statement praising the stiff penalties. “Today’s action is tangible evidence that every dispute doesn’t need to result in a lawsuit,” Dick Weekley, president of the group, said.

More information about the penalties is available on the Texas department Web site, at