Molina Healthcare Fined $600,000 by Washington State

IMPORTANT: If you’ve had serious problems with Molina, please fill out this short survey to help me gather information about the company’s harms. You can read more about this below.

On May 2nd, 2019, Washington State’s Office of the Insurance Commissioner fined Molina Healthcare $600,000 with $200,000 suspended and a compliance plan. Molina acted wrongly in a number of areas including incorrect billing for mammograms and emergency visits and denying care for Autism.

The details are in Order 19-0240 below and you can read much more detail in the Consent Order Levying a Fine against Molina (pdf).

This year I feel actively scammed by my Molina health insurance. Of my dozens of complaints against the company, I was surprised that the one thing they paid up without argument was my out of network provider bill from the in network Swedish Hospital emergency room. Now I know why! They’re on their best behavior to avoid more penalties.

Details of the Molina Fine, Order 19-0240

“$600,000 fine with $200,000 suspended and a Compliance Plan for failing to maintain adequate arrangements to:

• ensure reasonable proximity of network providers and facilities, failing to make good faith attempts to contract with provider groups offering services within hospital emergency departments,
• failing to timely respond to inquiries of the Insurance Commissioner, failing to provide responses in writing and submit them using the Insurance Commissioner’s electronic company complaint system,
• erroneously applying cost-sharing to mammograms,
• erroneously applying a deductible to emergency room visits,
• improperly denying Autism therapy claims,
• failing to follow grievance procedures,
• failing to maintain an accurate provider directory,
• failing to follow standard protocol for tracking appeal,
• failing to provide a written response within the timeline established by the plan’s grievance procedures,
• and retroactively terminating coverage due to a systems failure.

The Company violated WAC 284-170-200(6), WAC 284-170-260, WAC 284-170-370, WAC 284-30-360(2), WAC 284-30-650, WAC 284-43-5642(9)(e)(ii), WAC 284-43-5800(4), WAC 284-170-431(1), RCW 48.18.190, RCW 48.18.520, RCW 48.46.291, RCW 48.43.530(5)(c), RCW 48.46.100, RCW 48.18.180(1), RCW 48.46.380, justifying the imposition of a fine under RCW 48.05.185, RCW 48.46.130(2), and RCW 48.46.135.”

Share Your Story With Me

If you would like to share any complaints you’ve had with Molina, please fill out this short survey. If there is an opportunity for us to make a difference, I will contact you. You can alternately file your own complaint via the Washington Office of Insurance Commissioner (OIC) but I have generally found they are complicit with the insurers and not helpful to consumers.

I’ve written before about Molina and Swedish Hospital misleading prospective insured members and insurance agents about anesthesiology coverage during the 2018 enrollment period.

If you received a surprising bill for out of network care at an in network provider or facility or you received an anesthesia bill for surgery at Swedish, please, definitely, fill out the survey.

I will be writing more about the Washington State health insurance system and Molina soon. Keep up to date by following me on Twitter or subscribing to my blog using the form on the right, or at the bottom.