Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Your Practice

North Carolina Finds Precertification, Claim Processing Delays

Your article was successfully shared with the contacts you provided.

The North Carolina department negotiated the fines in connection with a settlement agreement with CIGNA Healthcare of North Carolina Inc., a unit of CIGNA Corp., Philadelphia (NYSE:CI), officials say.

As required by North Carolina state law, the fines will go to the state public school system, officials say.

CIGNA Healthcare also agreed to pay about $638,000 in refunds and credits to affected employer group policyholders, officials say.

The North Carolina department discovered the problems during an exam that begin in September 2005 and covered the period from 2002 through 2004, officials say.

The violations included “widespread failure to maintain adequate records in numerous areas of review, failure to accurately and consistently calculate premium rates in accordance with rating methodology filed with and approved by the department; failure to timely process precertification requests; … [and] failure to process claims timely.”

CIGNA also failed to respond to member communications in a timely fashion failed to submit accurate filings certifying compliance with North Carolina advertising laws, and failed to provide sufficient monitoring of the activities of delegated entities, officials say.

CIGNA says in a statement that it supports the North Carolina department market conduct exam program.

“As part of the review conducted in 2005, the department found that CIGNA made some documentation mistakes and was unable to consistently prove how it determined premiums for some of its clients,” CIGNA says. “As a result, the department found that some CIGNA clients were charged incorrect premiums. Clients were charged the rate they agreed to pay for our products and services as the errors took place in the calculation of the rate before it was presented to the employer.

“We apologize for the problems and we are working closely with the Department of Insurance to rectify this situation. CIGNA has changed its internal documentation processes to ensure that this will not be an issue moving forward.”

CIGNA is still trying to get refunds to some clients, the company says.

Other clients underpaid because of the problems, and those customers will not be asked for additional funds, the company says.

Other Carolinas coverage from National Underwriter Life & Health:


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.