Highmark fined $363,570 over reimbursements not going to volunteer ambulance companies

Delaware Insurance Commissioner Trinidad Navarro announced Highmark was fined $363,570 for improper volunteer ambulance company claims reimbursement.

The probe began after reports were received that payments were going to residents rather than to volunteer ambulance companies.

"The cost of health care and complexity of insurance processes are already a burden on the minds of Delawareans. The last thing Delaware families need after a medical event requiring an ambulance is to receive mixed messages on the cost," said Navarro. "The practice of sending mysterious checks to residents and waiting for them to be separately billed by the volunteer ambulance company rather than following the law and paying the provider directly causes confusion and delays for all involved. We're grateful that consumers reported this issue so we could act."

Through the 33-month period investigated, nearly 400 claims were found to be paid by Highmark to the subscriber or a third party, rather than to the volunteer ambulance company as required by law. The practice placed a burden on volunteer ambulance companies, while causing confusion for the consumer and in some cases prompting them to be billed directly by the ambulance company.

Also identified were 89 instances of refusing to pay claims without conducting a reasonable investigation based upon all available information. These claims rejections occurred in cases where patients presented symptoms at a physician's office but required emergency care and were transported to a hospital/facility.

Ambulance companies have been facing rising cost challenges and labor shortages that have led to the hiring of more paid personnel.

Highmark is the state's largest health insurer.