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Insurance Fraud

Baltimore, MD: (Sep-25-07) Maryland state officials brought a lawsuit against CareFirst BlueCross BlueShield, alleging that Maryland's largest health insurer improperly denied claims. The violations were revealed following an audit that was conducted in 2004. The complaint stated that the company had unethical business practices that led to the claims being rejected. Insurance Commissioner Ralph Tyler said CareFirst not only wrongfully denied claims, in some cases it was failing to process the denials within 30 days, which is also illegal.

In a settlement reached, CareFirst BlueCross BlueShield agreed to pay the $125,000 fine levied on it by the state. CareFirst has also entered into a consent decree with the Maryland Insurance Administration that calls for the company to correct the practices that led to the claims being rejected. [MARYLAND DAILY RECORD: INSURANCE FRAUD]

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Published on Sep-27-07


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I was diagnosed with Cancer on January 18th, 2007. Humana has denied my claim stating it was a pre-existing condition. I appealed their decision, and even had my Doctor send them a letter, stating that I had never been seen with any symptoms relating to cancer. They have denied my appeal on 1 Oct 2007.


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