For denying certain emergency room claims
The Pennsylvania Insurance Department has worked with the Office of Attorney General to take action against Pennsylvania-based HealthAmerica and its affiliate HealthAssurance, for denying certain emergency room claims.
HealthAmerica was accused of using standards that were too high and improperly denying claims. The insurer has now agreed to re-process claims and pay bills for more than 600 consumers as part of a legal settlement.
Joel Ario, commissioner of Pennsylvania Insurance, said: “No one should have to worry whether their insurance company will cover emergency care when they believe their life is at risk. That is why we use certain standards that require health plans to base coverage of emergency care on a patient’s symptoms, not the final diagnosis. We are looking at other health insurers now to be sure they are properly applying this standard.
“Many of us will find ourselves in need of a trip to the emergency room at some point in our lives, and these trips don’t come at a small cost. If you believe you needed immediate emergency treatment and your insurance company will not pay the claim, then you have a right to appeal the denial.”