BALTIMORE—Maryland consumers received more than $1.1 million in additional claims and interest payments after the Maryland Insurance Administration recently ordered three CareFirst companies to reprocess thousands of claims that had been improperly denied.
During a market conduct examination by the Maryland Insurance Administration, it was discovered that the companies – CareFirst of Maryland Inc., CareFirst BlueChoice Inc., and Group Hospitalization & Medical Services Inc. – failed to route denied claims for medical necessity without obtaining required physician or medical director review. Upon further investigation, the claims that were denied improperly were identified and reprocessed.
CareFirst of Maryland reprocessed 1,640 claims, paying additional benefits and interest totaling $506,144. CareFirst BlueChoice reprocessed 1,307 claims, paying consumers additional benefits and interest in the amount of $459,448. Group Hospitalization & Medical Service reprocessed 832 claims, paying additional benefits and interest in the amount of $191,855. In addition to ordering the companies to pay the denied claims, the Maryland Insurance Administration fined the companies a combined $377,900.
The administrative orders can be viewed on the Maryland Insurance Administration’s website:
MIA-2012-08-013: Group Hospitalization & Medical Services Inc.
http://www.mdinsurance.state.md.us/sa/documents/MIA-2012-08-013-GHMSI.pdf
MIA-2012-08-014: CareFirst of Maryland Inc.
http://www.mdinsurance.state.md.us/sa/documents/MIA-2012-08-014-CareFirst.pdf
MIA-2012-08-015: CareFirst BlueChoice Inc.
http://www.mdinsurance.state.md.us/sa/documents/MIA-2012-08-015-CareFirstBlueChoice.pdf
The Maryland Insurance Administration (MIA), founded as the Maryland Insurance Division in 1872, is an independent State agency located in downtown Baltimore. This agency regulates Maryland’s $26 billion insurance industry and makes certain that insurance companies, health plans and producers (agents and brokers) comply with Maryland insurance law. The MIA also licenses more than 110,000 producers and approximately 1,500 insurance companies, regulates insurance rates, monitors insurer solvency, investigates consumer complaints and travels across the State providing consumers with educational materials on insurance. These materials may also be found at http://www.mdinsurance.state.md.us.
Source: Maryland Insurance Administration (MIA)