A major North Carolina health insurer has been fined $3.4 million for violations related to protecting patients from excess medical costs.

UnitedHealthcare of North Carolina failed to prevent out-of-network providers from trying to collect excess costs through “balance billing,” Insurance Commissioner Mike Causey said Friday in a news release.

“Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and make sure all providers attending them are in-network,” Causey said. “UnitedHealthcare’s practices potentially put unnecessary financial burdens on many North Carolinians.”

UnitedHealthcare agreed to a voluntary settlement with the state Department of Insurance but did not admit to the agency’s findings and denied violating any rules. The settlement includes the affiliate UnitedHealthcare Insurance Co.

Balance billing occurs when an out-of-network provider charges more for a service than the insurer allows and tries to collect the extra cost from the patient.

A patient's cost-sharing responsibilities shouldn't be affected if an insurer fails to have in-network service providers at in-network facilities, the department said.

After noticing a trend in complaints, state investigators looked at claims for anesthesia and emergency room services to see whether UnitedHealthcare was following procedures to protect its members, the Department of Insurance said. The investigators found that in some case, when members filed grievances, they were simply told they were responsible for all costs, and that UnitedHealthcare failed to intervene on behalf of patients who filed grievances.

In addition to the fine, UnitedHealthcare will come up with a plan to fix the violations.

UnitedHealthcare insures 1.8 million people in North Carolina through Medicaid and other government health care programs, according to the company.