UnitedHealth Coverage Probe
Texas Attorney General Investigates UnitedHealth Over Alleged Improper Coverage Denials
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Paxton said, “No Texan should be denied medically necessary care, dragged through endless appeals, or stuck with devastating bills after trusting their insurer’s word,” and said his office would gather evidence and seek to ensure Texans receive the coverage they pay for.
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The investigation follows a separate probe Paxton announced one week earlier into Blue Cross Blue Shield of Texas over allegations involving prior authorization and delays or denials of medically necessary care.
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Paxton’s office said delays in care can increase the risk that patients receive treatment too late, and alleged that denying care physicians deem medically necessary can harm patients.
Texas Attorney General Ken Paxton is investigating UnitedHealth Group over allegations that the insurance giant improperly denied or delayed medically necessary care. Texas Attorney General The probe centers on claims that UnitedHealth incentivized nursing homes to avoid hospital transfers and overrode doctors' medical judgments. Dallas News Paxton's office has issued civil investigative demands seeking company records to determine if UnitedHealth violated the Texas Deceptive Trade Practices Act.
The investigation highlights a pattern of insurance denials affecting Texas patients. One patient had a procedure initially approved but lost coverage after the surgery was completed, leaving them with a large unexpected bill. Washington Examiner Paxton said: "No Texan should be denied medically necessary care, dragged through endless appeals, or stuck with devastating bills after trusting their insurer's word."
Nursing Home Incentives and Doctor Overrides
UnitedHealth allegedly encouraged nursing homes to delay or prevent hospital transfers for patients who needed more advanced care. Dallas Express The company is also accused of overriding treatment decisions made by patients' own physicians. WBAP These practices raise serious concerns because delays in hospital care can mean patients receive lifesaving treatment too late, potentially worsening their health outcomes.
Prior Authorization Denials Leave Patients With Surprise Bills
One Texas patient had their procedure approved by UnitedHealth before surgery. But after the operation was completed, the company withdrew its approval—forcing the patient to pay the entire bill out of pocket. Washington Examiner This reversal leaves families facing financial devastation after following their insurer's initial authorization.
Part of Broader Crackdown on Insurance Denials
This investigation is the second major insurance probe Paxton launched in just one week. His office also opened an inquiry into Blue Cross Blue Shield of Texas over similar allegations involving prior authorization delays and denials of necessary care. Dallas News The pattern suggests Texas insurers may be systematically denying or stalling coverage to reduce costs.
What Paxton Is Demanding From UnitedHealth
Paxton's office has issued civil investigative demands requiring UnitedHealth to hand over internal records and documents. Market Screener These materials will help investigators determine whether the company violated state consumer protection laws. As of the investigation's announcement, UnitedHealth had not publicly responded to the allegations. The company faces potential penalties if violations are proven.
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