DELAWARE - Highmark has been penalized $363,570 by the Delaware Department of Insurance following a nearly years-long investigation into improper reimbursement practices involving volunteer ambulance companies, Insurance Commissioner Trinidad Navarro announced Tuesday.
The Delaware Department of Insurance says that investigations began after reports were received that payments were going to residents rather than directly to volunteer ambulance companies for payment of services.
"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," said Commissioner Navarro. "We’re grateful that consumers reported this issue so we could act."
According to the Department of Insurance, during the 33-month period under investigation, nearly 400 claims were identified that 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.
Also identified were 89 instances of the insurance company refusing to pay claims without conducting a reasonable investigation based upon all available information. These improper claims rejections occurred in cases where patients presented symptoms at a physician’s office but required emergency care and were transported to a hospital/facility, said the state.