DOVER, DE — The Delaware Department of Insurance recently levied penalties totaling $363,570 against Highmark after a lengthy investigation into improper reimbursement practices involving volunteer ambulance services. This action follows a comprehensive Market Conduct investigation prompted by reports that payments intended for ambulance companies were erroneously sent to residents.
Insurance Commissioner Trinidad Navarro highlighted the undue burden this placed on Delawareans, stating, “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.” He further criticized the confusion and delays caused by Highmark’s practice of sending checks to residents instead of paying service providers directly.
The investigation, spanning 33 months, identified nearly 400 claims improperly handled by Highmark, leading to delayed or impeded reimbursements for volunteer ambulance companies. Additionally, it uncovered 89 instances where Highmark refused to pay claims without adequate investigation, impacting patients requiring emergency care.
These findings underscore significant lapses in adherence to insurance regulations, with Commissioner Navarro emphasizing the need for compliance to maintain trust and functionality within Delaware’s healthcare system.
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