UnitedHealthcare to pay $91M after denying coverage to some patients

UnitedHealthcare, the nation’s largest health insurer, will have to shell out $91 million to patients who were wrongfully denied coverage for some healthcare services.

The California Supreme Court solidified the ruling, which was made late last year in a California appeals court. The case goes back roughly a decade, after the California insurance commissioner’s office found more than 900,000 violations involving patient claims and other issues with UnitedHealthcare’s subsidiary, PacifiCare, around the merger between the two in 2005, CNN reported.

The practices led to denied coverage and access to medical care for some patients. The decision effectively brings more power to the insurance commissioner’s office as a regulator and has national implications for other major insurers.

See the full story below:

Amy Baxter

Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."

Around the web

The tirzepatide shortage that first began in 2022 has been resolved. Drug companies distributing compounded versions of the popular drug now have two to three more months to distribute their remaining supply.

The 24 members of the House Task Force on AI—12 reps from each party—have posted a 253-page report detailing their bipartisan vision for encouraging innovation while minimizing risks. 

Merck sent Hansoh Pharma, a Chinese biopharmaceutical company, an upfront payment of $112 million to license a new investigational GLP-1 receptor agonist. There could be many more payments to come if certain milestones are met.