DOVER, DE - Healthcare company Highmark has been fined more than $363K following an investigation into ambulance payments.
On Sept. 3, Insurance Commissioner Trinidad Navarro announced penalties against Highmark totaling $363,570 relating to improper volunteer ambulance company claims reimbursement. The penalty comes after a nearly years-long Market Conduct investigation, which began after reports of payments going to residents rather than directly to volunteer ambulance companies for services.
“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,” shared Commissioner 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.”
The Delaware Department of Insurance says through a 33-month investigation, 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. Officials say this delays, or wholly prevents, much-needed reimbursements from reaching the volunteer ambulance companies, while causing confusion for the consumer and in some cases prompting them to be billed directly by the ambulance company.
Officials also identified 89 instances of refusing to pay claims without conducting a reasonable investigation based upon all available information. These improper claims rejections reportedly occurred in cases where patients presented symptoms at a physician’s office but required emergency care and were transported to a hospital/facility.
