"It is

unfortunate that fines must be imposed to encourage compliance. Consumers

and doctors deserve prompt payment," Commissioner Oxendine said.

"While some plans have improved since our last review, I will continue

to aggressively pursue those who do not comply with the law."

A dozen plans

were collectively fined more than $1 million following initial reviews

in 2000 and 2001. The purpose of the reviews is to ensure that managed

care plans are paying claims within 15 working days, or notifying the

provider or policyholder why a claim can't be paid, as Georgia law requires.

The fine announced today against One Health Plan is the second HMO fine

based on the latest round of reviews of managed care plans.

To ensure managed

care plans were complying with Georgia law, Oxendine issued a directive

in August 1999 that all healthcare plans licensed in Georgia would be

required to submit claims data every quarter, beginning with the third

quarter of 1999. Since then, no HMO reviewed has been in100 percent compliance

with the law. The Commissioner has repeatedly warned healthcare plans

that strict compliance with the law is expected.

Consumers having

difficulty with their HMO or with any insurer should contact Commissioner

Oxendine's Consumer Services Division at 404-656-2070 or 1-800-656-2298

from 8 a.m. to 7 p.m., Monday through Friday, or they may visit the Department's

Web site at www.gainsurance.org to obtain a complaint form and

instructions for submitting it.

Back

to Healthwise Home Page |