Pennsylvania Fines Independence Health Group $165K For Violations

Mar. 3--Pennsylvania fined Independence Health Group $165,000 for the "improper and inconsistent" handling of claims and coverage for autism, mental-health, and substance-abuse disorders, the state's Insurance Department said Monday.

The examination of Independence's practices covered the period from January 2015 through December 2017 and was one of a series of insurance company reviews required by the Affordable Care Act. Independence is the parent company of Independence Blue Cross, AmeriHealth Caritas, and AmeriHealth New Jersey.

Regulators also found violations of the Unfair Insurance Practices Act relating to customer service and claims handling, as well as prompt payment and interest calculations, the insurance department said.

"Independence has been extremely cooperative and thorough in its response to examiner findings and is conducting root cause analyses and reviewing processes for immediate remediation," Insurance Commissioner Jessica Altman said in a news release.

Independence said in a statement that it took the examination process very seriously. "We made changes quickly when the examination revealed opportunities for improvement. We always want to improve how we serve our valued members and are addressing all the recommendations from the report," the Philadelphia company said.

Last November, the department fined insurance giant United Healthcare $1 million for denial of, or sometimes failure to pay, customers' claims relating to mental-health care.

Aetna underwent a similar examination earlier and was fined $190,000 for violating rules on coverage of drug- and alcohol-abuse treatment and coverage of autism spectrum disorder.

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