09-02-2025
NC Commissioner fined UnitedHealthcare $3.4M for unfair billing practices against patients
RALEIGH, N.C. (WNCN) — UnitedHealthcare of North Carolina is facing allegations from the state that they violated regulations behind billing their patients.
In an investigation that took four years to build, North Carolina Insurance Commissioner Mike Causey fined the healthcare provider $3.4 million Friday claiming the company incorrectly handled balance billing.
Balance billing is when health insurance providers bill a patient the difference between the amount they charge and the amount the insurance approves for the patient in their healthcare plan.
In this case, Commissioner Causey said in his investigation he found multiple instances where UnitedHealthcare of NC did not follow its own procedures to negotiate with non-contracted facilities and providers for anesthesia services and emergency room services — footing members with the leftover balance.
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'Patients receiving emergency room services certainly don't have the time or capacity to go through a checklist and make sure all providers attending them are in-network,' Commissioner Causey said. 'UnitedHealthcare's practices potentially put unnecessary financial burdens on many North Carolinians. I am happy to see that UnitedHealthcare has agreed to take corrective action.'
Members of UnitedHealthcare of NC filed complaints to the state's insurance department, and in their investigation, the state said their review found that members were subjected to cost sharing more than applicable deductible, copayment and coinsurance liabilities.
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In addition to paying the multi-million dollar fine, Commissioner Causey said UnitedHealthcare of NC agreed to provide the Department of Insurance with a corrective action plan to confront violations found in the investigation and submit to future compliance examinations.
Commissioner Causey said the $3.4 million fine will be distributed for the benefit of the public schools, as required under Article IX, Section 7 of the North Carolina Constitution.
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