Two healthcare insurance giants will have to reimburse hundreds of overcharged Virginia customers.
According to WDBJ 7, a Bureau of Insurance Investigation found that Anthem erroneously charged a copay to customers for a brand name contraceptive their doctors deemed medically with no generic alternative. In Virginia, insurance companies are required to cover preventive services without charging co-pays. The Virginia State Corporation Commission ordered Anthem to pay back 446 Virginians who filed claims between 2021 and 2024, totaling $216,964.
The commission ordered Cigna Healthcare to reimburse 457 customers approximately $404,000 because the investigation found the company had told customers that it would lower the amounts paid based on the level of Medicare coverage patients had. The state of Virginia prohibits this.
Healthcare Insurance Companies Under Scrutiny
Health insurance companies have faced public scrutiny over the last few months following the death of UnitedHealthcare CEO Brian Thompson. Thompson was shot and killed outside a Midtown Manhattan hotel while attending a conference with UnitedHealthcare investors. His death sent shockwaves and sparked criticism nationwide about how the industry treats customers.
UnitedHealthcare is the country’s largest private health insurer by market share. It has been the subject of lawsuits for allegedly denying claims to maximize profits.
Late last year, a KFF survey found that roughly 6 in 10 insured adults have experienced problems with their health insurance. Some of these issues range from denied claims to preauthorization delays and denials.
However, an investigation found that a hidden industry makes money by rejecting doctors’ payment requests, known widely as prior authorizations.
As BLACK ENTERPRISE previously reported, the company EviCore by Evernort is a key player in assisting health insurance companies with rejecting claims. A ProPublica investigation found that EviCore is owned by the major insurance company, Cigna. The majority of American insurance companies that hire EviCore provide coverage to 100 million consumers.
EviCore reportedly uses an algorithm backed by artificial intelligence that insurance insiders call “the dial.” The algorithm system can be adjusted, ultimately leading to higher denials of preauthorization claims.
RELATED CONTENT: How Candice Ray Is Pioneering Holistic Senior Care With Personalized Wellness And Support