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N.C. Regulator Settles With Health Insurer

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North Carolina’s Department of Insurance has entered into a settlement agreement with UnitedHealth Group Inc. and UnitedHealthCare of North Carolina, Inc. to resolve complaints involving claims payment and other issues.

Under the agreement, the companies will pay a fine of $786,655, state Insurance Commissioner Jim Long announced.

According to the NCDOI, it first heard complaints from consumers about the companies’ claims settlement and payment practices in 2003 and 2004. Following an investigation, the department ultimately fined both companies as part of a settlement agreement in 2004.

After that agreement, NCDOIE participated in a multistate examination of UnitedHealth practices, including claims processing and payment, coordination of benefits, and complaint resolution.

Earlier this year, 36 states and the District of Columbia arrived at an agreement with UnitedHealth, Minnetonka, Minn., over the alleged violations. North Carolina, however, declined to take part, objecting to restrictions the agreement would have placed on own future examinations and activities.

The NCDOI says its new agreement includes most of the major provisions from the multistate agreement and provides that NCDOI expects to participate in continuing multistate examination actions arising out of the multistate agreement.

“While this week’s agreement mirrors much of the multistate agreement, this agreement also gives NCDOI the flexibility to address future issues as they arise,” the department said in a statement.


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