A Harrisburg-based health insurance company - HealthAmerica and HealthAssurance Pennsylvania Inc. - has reached an agreement with the Pennsylvania Attorney General's Office over complaints that it improperly rejected emergency room treatment claims from more than 600 subscribers across the state, the Attorney General's Office said today.
HealthAmerica agreed to reprocess and pay $445,981 in claims. Most of that money will go to hospitals and doctors whose bills were rejected, said Nils Frederiksen, deputy press secretary for Attorney General Tom Corbett.
The company will pay $10,000 in civil penalties to the state and $50,025 to cover investigation expenses. The company's insurance plans - and state law - required it to pay claims involving symptoms that would lead a "prudent layperson" to choose to go to the emergency room.
Corbett's office said HealthAmerica was using a higher standard.
In a written statement, HealthAmerica said it did not admit any wrongdoing, but agreed to cooperate with the attorney general as a "good corporate citizen."
The company said it has adjusted its emergency claims payment guidelines "as appropriate." The company added that "misuse of the emergency room continues to drive up health-care costs for everyone."