A pair of St. Louis, Mo-based subsidiaries of UnitedHealthcare will pay $536,000 in fines and review 50,000 chiropractic claims it denied in 2004 in an agreement with Missouri regulators.

Through a settlement between the insurer and the Missouri Department of Insurance, UnitedHealthcare will reexamine the claims filed by chiropractors who treated the company’s policyholders after regulators determined the company violated state law by limiting coverage to 26 visits per year.

In other cases, the insurance department says UnitedHealthcare failed to evaluate the medical necessity of treatment before denying claims.
For any chiropractic claims it finds were improperly denied, UnitedHealthcare must reimburse the specialists for those claims, plus interest and in some cases, consumers may have paid the bills, rather than their specialists.

John M. Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, said his agency believes the review of 50,000 cases may determine money is due to both providers and possibly consumers.

“When Missourians entrust their health coverage to an insurance company, they expect and deserve to be treated fairly and legally. We have taken this action to make sure that happens,” Huff said in a statement.

After patients and chiropractors filed complaints about UnitedHealthcare denying claims, the DIFP conducted a market conduct examination of the insurer, starting at the the time a state law on chiropractic visits took effect.

A 2004 Missouri law requires health insurance companies cover the costs of at least 26 chiropractic visits per year without prior authorization. For those first 26 visits, coverage can only be denied if the treatment is deemed not to be medically necessary.