August 13, 2015
Missouri Department of Insurance fines health insurer Cigna for violations
Health insurer incorrectly denied chiropractic claims
Jefferson City, Mo - The Missouri Department of Insurance has fined Cigna subsidiaries $140,800 for using unapproved forms, incorrectly denying chiropractic claims, charging copayments of more than 50 percent and failing to send an explanation of benefits to members.
"Our market conduct team uncovered numerous violations where an insurer unjustly denied claims to consumers. Regulators are now requiring Cigna to take corrective measures," said Department of Insurance Director John M. Huff. "In addition to the fine, Cigna has also agreed to review its practices to bring them in compliance with Missouri law."
Cigna subsidiaries have agreed to review denied chiropractic claims and pay appropriate restitution, stop imposing copayments in excess of 50 percent, review claims to determine if copays exceed 50 percent and pay appropriate restitution to Missouri consumers for amounts due.
Cigna previously had separate companies, Cigna Healthcare of St. Louis and Cigna Healthcare of Ohio, which have since merged. Anthem announced in July it has entered into a definitive agreement to acquire Cigna Corp., subject to regulatory approval.
In market conduct exams and investigations, the Department of Insurance reviews insurance company practices regarding the treatment of policyholders. This includes the way premium rates are charged and claims are handled. These reviews can result in refunds for consumers, fines and corrections in business practices, as well as other remedies. Since the beginning of 2009, market conduct enforcement actions have generated more than $41 million in payments from insurance companies. The money goes toward refunds for consumers, general revenue and the Missouri State School Fund. To learn more about the market conduct section and how it helps ensure a fair marketplace in Missouri, watch DIFP Weekly.
Consumers who have complaints or general questions about insurance, can call the department's Insurance Consumer Hotline at 800-726-7390 or by visiting insurance.mo.gov.