Two health insurers ordered by Va. SCC to reimburse hundreds for overcharges

RICHMOND — Two of the state's biggest health insurers must reimburse more than 900 Virginians for overcharges, the State Corporation Commission ordered.

It ordered Cigna Healthcare to pay 457 customers a total of nearly $404,000 after the insurer told them it reduced the amounts it paid on claims based on patients' eligibility for Medicare.

Such reductions are prohibited, and telling customers incorrect information about that is a violation of state law, the commission said.

In addition, Cigna paid $137,000 to settle the commission's Bureau of Insurance investigation into whether its communications with customers about Medicare eligibility were misleading.

"This offer is being made solely for the purpose of a settlement and does not constitute, nor should it be construed as, an admission of any violation of law," Katie Stewart, Cigna's regional vice president, said in a letter to Julie Blauvelt, the insurance bureau's deputy commissioner.

Cigna also agreed to update its standard operating procedures for all staff who assist with its individual and family plan policies.

Separately, the commission ordered Anthem and its HealthKeepers-managed care plans to reimburse 446 Virginians nearly $217,000. The error involved 1,287 claims.

The issue was that Anthem and HealthKeepers imposed cost-sharing requirements for certain preventive services, when this was not allowed, the commission said.

Anthem erroneously charged a copay to members for a brand name contraceptive with no generic alternative, when the prescribing doctor determined that the contraceptive was medically necessary for the patient, a Bureau of Insurance investigation of a customer's complaint found.

The Code of Virginia says health insurers have to cover preventive services, including contraception, and that they cannot charge any co-payments or require out of pocket spending to satisfy coinsurance or deductible requirements.

Anthem said that the error was due to an incorrect system configuration, and it affected claims made between 2021 and 2024.