Insurance Department Exam Finds UPMC Violations


January 6, 2022

Insurance Commissioner Jessica Altman announced a $250,000 penalty stemming from a comprehensive Affordable Care Act market conduct examination that the Pennsylvania Insurance Department (PID) conducted on the practices and procedures of UPMC Health Coverage, Inc. and UPMC Health Options, Inc.

The UPMC examination, which covers the period from Jan. 1, 2015, to March 31, 2016, identified claims processing violations, including claims being denied when they should have been paid and notification and processing delays. The examination also reported Unfair Insurance Practices Act violations rel...

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