Montanans Owed Money By Fortis On Health Insurance Claims

People who have or had Fortis or John Alden health insurance coverage that
is affected by this agreement should be receiving a letter in the mail. Claims that are being reviewed are primarily maternity, but persons who were covered by the student medical plan, may also be asked to resubmit claims relating to diabetes, well-child care, inborn errors of metabolism, mammography, post-mastectomy care, reconstructive breast surgery, mental illness, alcoholism, drug addiction and student medical coverage. The agreement only covers claims incurred since January 1, 2002.  If you receive a letter you should be aware of the following:

* Your time to re-submit your claim is limited to 60 days after receiving
notice, so act quickly.
* Even if you feel you are lacking critical paperwork, call Fortis Health at
1-800-800-1212 immediately and ask what you need to do to ensure your claim
is paid properly.
* Remember, physicians can often re-print your bills, so don't be afraid to
call your doctor if you can't find all your paperwork.
* If you have additional questions or problems, do not hesitate to call the
State Auditor's Office at 1-800-332-6148.

"Claims are being reviewed on a case-by-case basis," said State Auditor John
Morrison. "It is important that Montanans who have health insurance are getting the full benefits that they are paying for. I am committed to making sure that people who were affected by these issues are properly reimbursed."

The investigation of Fortis Health stemmed from a number of complaints to
the State Auditor's Office. "Fortis Health has been very willing to correct the problems that were brought to their attention as part of this investigation and worked diligently with the department to resolve these matters," said Morrison. "We anticipate they will be in full compliance in the future. They play an important role in the health insurance market in Montana. "

As part of the settlement Fortis Health has agreed to correct the following
issues:
* Failure to send certificates of creditable coverage or sending
certificates of creditable coverage that did not include the notices
required by Montana law.
* Executing a product withdrawal in 2002 without complying with Montana law.
* Issuing coverage using an unapproved student medical certificate that
failed to provide certain coverage required under Montana law including
maternity and diabetes.
* Failing to consistently provide firm price quotes to small employer
groups.
* Failing to provide maternity coverage including coverage for complications
of maternity.