Louisiana Insurance Commissioner Issues Cease and Desist Order to United HealthCare for Intention to Omit Producer Commissions in Louisiana
Insurance Commissioner Jim Donelon issued a cease and desist order today to United HealthCare Services, Inc. and/or UnitedHealthcare Insurance Company, its subsidiaries and affiliates (collectively hereafter referred to as “United”) for their intention to implement the removal of producer commissions from upcoming renewals of certain group health insurance products.
“In reviewing this situation I found it necessary to order the company to stop all efforts to implement such policy and to revise all applicable schedules of commissions and relevant rate and form filings to appropriately reflect the full commission payment required by law,” Commissioner Donelon stated. “This action is meant to both protect Louisiana’s health insurance producers who are due compensation and preserve our authority in making sure insurers writing in Louisiana are in compliance with our laws.”
The Louisiana Department of Insurance (LDI) was contacted in May by numerous producers who indicated that they had been notified of United’s intention to implement a zero-dollar schedule of commissions applicable to all policies sold to groups of greater than 100 insureds with an effective date on or after September 1, 2019. Accompanying this notification was an inducement to work with United and affected insureds to negotiate a “replacement” agency fee to be paid by the insured to the producer and an offer by United to facilitate this payment.
According to insurancenewsnet.com Health Agents for America President/CEO, Ronnell Nolan said, “It’s really appalling because our members have been fighting to get paid, and that bill is important. Lowering health care costs is what we want for our clients. But our members aren’t getting commissions on the individual market and UnitedHealthcare is not even paying for groups of 50 and above. So how can anybody point the arrow toward our members and say we’re part of the problem? We’re not part of the problem. Agents have been losing money since the passage of the ACA."
Health Agents for American (HAFA) stormed Capitol Hill last week and several of its top agents were invited to a round table discussion at Centers for Medicare & Medicaid Services (CMS), also known as The Federal Marketplace.
We were able to bring our concerns and experiences dealing with the Marketplace directly to the CMS staff.
The trip to Washington also provided us with the opportunity to hear from our legislators on healthcare issues that are currently being addressed in the Senate. According to HAFA President/CEO, Ronnell Nolan, "We learned about exciting legislation from Senator Bill Cassidy to fight balance billing."
Members of the bipartisan Senate health care price transparency working group, released draft legislation to protect patients from surprise medical bills. The draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.
Recent examples of patients receiving surprise medical bills referenced by HAFA include a patient who received a bill of nearly $109,000 for care after a heart attack, and a patient who received a bill for $17,850 for a urine test.
The discussion draft of the Protecting Patients from Surprise Medical Bills Act addresses three scenarios:
1. Emergency services provided by an out-of-network provider in an out-of-network facility:
The draft bill would ensure that a patient is only required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.
2. Non-Emergency services following an emergency service from an out-of-network facility:
The draft bill would ensure that if a patient receives an emergency service from an out-of-network health care provider or facility and requires additional services after being stabilized, the health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility. The patient, or their designee, would also be required to sign a written acknowledgment of that notification.
3. Non-Emergency services performed by an out-of-network provider at an in-network facility:
The draft bill would ensure that a health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing in the case of a non-emergency service that is provided by an out-of-network provider in an in-network facility. The excess amount above the cost-sharing amount will be paid by the patient’s health plan in accordance with an applicable state law or an amount based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125 percent of the average allowed amount for the service provided by a provider in the same or similar specialty and provided in the same geographical area.