Mega Life and Health Fined $20 Million for Market Conduct Issues

A Multi-State Market Conduct Examination of Mega Life and Health and its affiliates resulted in a whopping $20 million fine for market conduct violations.  http://www.oic.wa.gov/oicfiles/marketconduct/2007mc/MegaReportFinal.pdf. A Market Conduct Examination is when the insurance regulators examine an insurance company's practices.  The examination made several significant findings relevant to medical providers who deal with The Healthmarkets, Inc. Insurance Companies comprised of Mega Life, Mid-West Life National Life Insurance Company of Tennessee and The Chesapeake Life Insurance Company.  The examiners found 1) deficient claims handling practices, 2) changing CPTs codes while adjudicating claims, 3) delaying new claims while waiting for information on pending claims and 4) failing to adjudicate claims in the correct insurance entity.  All of these findings are significant to a medical provider trying to get paid from one of these entities.  Medical providers also need to be vigilant of any use of PPO discounts and UCR reductions by these entities.  With findings such as changing CPT codes and processing claims in the name of the wrong insurance entity, medical providers need to be on the watch for Silent PPO discounts and wrongful UCR reductions.