Date: July 14, 2006
For more information contact: Eileen Mallow, Assistant Deputy Commissioner, (608) 266-7843 or eileen.mallow@wisconsin.gov

Insurance Commissioner Announces UnitedHealthcare Settlement

Insurer required to implement long-term corrective action plan

Madison, WI—Wisconsin Commissioner of Insurance Jorge Gomez today announced that the UnitedHealthcare Group of companies entered into an agreement with his office to correct market conduct and customer service issues. The settlement agreement requires the group to implement a corrective action plan and a compliance program.

UnitedHealthcare agreed to the settlement after the Office of the Commissioner of Insurance's (OCI) investigation alleged that in 2004 and prior years, the company did not adequately respond to consumer complaints and grievances, notify insureds of, or process requests for, independent review of denied claims, and correctly pay for certain benefits.

"Consumers and providers need assurances that their health plan will fulfill service obligations. I am confident that the residents of Wisconsin will be protected under the agreement," Gomez noted. "UnitedHealthcare has implemented a compliance plan that will ensure each customer receives service that meets or exceeds provisions required under Wisconsin insurance regulations. My department will oversee UnitedHealthcare's performance under this compliance program and ensure that Wisconsin residents receive quality service."

As part of the agreement, UnitedHealthcare also agreed to pay a six hundred thousand dollar forfeiture. The agreement applies to the following subsidiaries that operate in Wisconsin: UnitedHealthcare of Wisconsin, Midwest Security Life Insurance Company and Unimerica Insurance Company. "This agreement involved extensive discussion between state regulators and representatives of UnitedHealthcare," according to Gomez. "UnitedHealthcare has made a significant commitment to improve its customer service and has expended substantial resources to develop and implement a compliance plan to meet Wisconsin requirements."

Publications that explain Wisconsin consumer protections in healthcare, such as "Consumer's Guide to Managed Care Health Plans in Wisconsin," and "Fact Sheet on Mandated Benefits in Health Insurance Policies," can be ordered free from the agency by writing to OCI Publications, P.O. Box 7873, Madison, WI 53707-7873, by calling 800-236-8517, or by visiting the OCI Web site at oci.wi.gov.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.