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Coventry Health Care subsidiaries agree to reprocess emergency claims

NEWS IN BRIEF — Posted Dec. 28, 2009

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HealthAmerica and HealthAssurance, subsidiaries of Bethesda, Md.-based Coventry Health Care, have agreed to reprocess hundreds of claims for emergency services for Pennsylvania members after an investigation by the state's attorney general.

The attorney general's office alleged that from 2001 to 2007, the companies improperly had denied coverage for emergency services under its policies' "prudent layperson" standard, which promises coverage for medical problems for which a reasonable person would have sought emergency treatment.

The agreement requires the company to reprocess the claims in question, worth nearly $446,000, and to pay $60,000 in fines and investigative costs.

The companies denied any wrongdoing.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2009/12/28/bibf1228.htm.

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