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Settlement Requires Humana to Refund $600,000 to Missouri Health Care Providers

Under a settlement with the state Department of Insurance, one of the nation’s largest health insurance companies will refund more than $600,000 to Missouri health care providers. Missouri’s insurance director today announced that Humana Insurance Company and Humana Health Plan LLC will make the payments after improperly collecting refunds from doctors and other providers.

Missouri law allows up to one year for health insurance companies to correct errors in claims processing. A comprehensive investigation by Missouri Department of Insurance Market Conduct Section found that Humana frequently sought reimbursement from providers in excess of a year after claims were paid.

Per the director of the Missouri Department of Insurance: “Many doctors in Missouri are small-business owners, and they need to know promptly if there’s a payment error. That’s why Missouri law gives health insurers no more than one year to make these calculations and bring providers the finality they need.”

Under the investigation, 1,052 improper reimbursements were found made to 247 health care providers across Missouri. Under the settlement, Humana is required to reimburse the providers $608,642 for funds that were improperly collected.

During market conduct exams and investigations, the department reviews insurance company practices regarding the treatment of the policyholders. These reviews can result in refunds for consumers, fines and corrections in business practices, and other remedies.

Read more here.

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