A major health insurance company is under investigation by Attorney General Ken Paxton over allegations that it engaged in deceptive and unlawful practices by denying Texans access to medically necessary healthcare.
According to the Office of the Attorney General, reports allege UnitedHealth Group Inc. engaged in unlawful practices while administering health insurance benefits and making decisions about patient care.
The OAG cited a case involving a Texas patient who received a letter from United approving a prior authorization request for a procedure at RedBud Surgery Center in Austin. After the procedure was completed, United allegedly sent the patient a second letter withdrawing the authorization, leaving the patient responsible for a large medical bill.
The investigation will also examine whether United’s coverage determinations improperly interfere with physicians’ medical judgment. Paxton’s office alleged that by denying treatment that a patient’s physician has determined is medically necessary, United may delay care, undermine physicians’ medical judgment, and potentially cause harm to patients.
“Alarming reports keep piling up about how United treats Texas consumers,” said Paxton. “I will not tolerate any insurance company putting illegal corporate greed over the people of Texas. No Texan should be denied medically necessary care, dragged through endless appeals, or stuck with devastating bills after trusting their insurer’s word.”
As part of the investigation, Paxton has issued Civil Investigative Demands to United seeking information about the company’s practices. The demands are intended to gather evidence concerning potential violations of the Texas Deceptive Trade Practices Act and other state laws.
The investigation comes as Paxton’s office examines similar allegations involving another major health insurer, Blue Cross Blue Shield of Texas (BCBSTX).
Earlier this month, Paxton launched an investigation into BCBSTX, its parent company Health Care Service Corporation, and related entities over alleged delays and denials of urgent and medically necessary care. The OAG cited a case involving a newborn whose transfer to a facility capable of providing needed treatment was allegedly delayed by administrative denials and utilization review procedures.
The BCBSTX investigation is examining the insurer’s use of prior authorization and whether it made misleading representations about its approval and denial of medically necessary claims. Paxton also issued Civil Investigative Demands to BCBSTX, HCSC, and related entities to determine whether they violated Texas law.
Neither investigation establishes that the companies violated the law. The investigations will determine whether the allegations are supported by evidence and whether further legal action is warranted.
