Two major health-insurance companies will have to reimburse hundreds of Virginia customers who were overcharged.
According to WDBJ 7, a Bureau of Insurance Investigation discovered that Anthem charged customers an incorrect copay for a brand name contraceptive that their doctors determined had no generic alternative.
In Virginia, insurance companies are required to cover preventive services with no copays. The Virginia State Corporation Commission ordered Anthem to pay $216,964 to 446 Virginians who filed claims between 2021 and 2024.
The commission ordered Cigna Healthcare to reimburse 457 customers for approximately $404,000 after an investigation revealed that the company had told customers that the amounts paid would be reduced based on the level of Medicare coverage patients had. Virginia prohibits this.
Healthcare Insurance Companies Under Scrutiny
Following the death of UnitedHealthcare CEO Brian Thompson, health insurance companies have faced increased public scrutiny in recent months.
Thompson was fatally shot outside a Midtown Manhattan hotel while attending a conference with UnitedHealthcare investors. His death sent shockwaves through the industry, sparking widespread criticism about how it treats customers.
UnitedHealthcare has the largest market share among private health insurers in the country. It has faced lawsuits for allegedly denying claims in order to maximize profits.
A KFF survey conducted late last year discovered that roughly six out of every ten insured adults have had problems with their health insurance. Some of these issues include denied claims, preauthorization delays, and denials.
However, an investigation discovered that a hidden industry makes money by rejecting doctors’ payment requests, also known as prior authorizations.
As BLACK ENTERPRISE previously reported, Evernort’s EviCore is a key player in assisting health insurance companies with claim rejection. A ProPublica investigation discovered that EviCore is owned by Cigna, a major insurance company. The majority of American insurance companies that hire EviCore cover 100 million people.
According to insurance insiders, EviCore employs an AI-powered algorithm known as “the dial.” The algorithm system can be changed, resulting in more preauthorization claim denials.