ERISA Suit Alleges UnitedHealthcare Reversed Approved Claim

July 18, 2023
Hall Benefits Law, LLC

UnitedHealthcare, Oxford Health Plans, LLC, and Oxford Health Insurance, Inc. are facing a lawsuit under ERISA and the Affordable Care Act (ACA) in a Connecticut federal district court concerning the alleged reversal of an approved claim. The plaintiffs allege that the companies denied coverage for midwife services after initially approving the care as in-network.

Plaintiffs Jonathan A. Winter, Rebecca E. Moore, and their son contend that they received a letter from the defendants stating that coverage for the midwife would be in-network, as it had been for the birth of their older child. However, the companies changed course after the couple used the midwife for the birth of their son, although the couple received no written communications altering the written approval they previously received.

The plaintiffs also claim that a representative of UnitedHealthcare encouraged them to use an internal appeals process rather than file a lawsuit since the company already had approved the midwife’s services. However, the plaintiffs stated in their complaint that they had already exhausted the internal claims processing options, including making several phone calls to the company and a formal appeal, which the company denied. In addition, according to the plaintiffs, none of the companies gave any reason for the reversal of their approved claim.

The plaintiffs are seeking to enforce their rights under ERISA and the ACA. They also are requesting equitable and legal relief, including compensatory damages, attorney’s fees, and court costs.

HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.

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Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

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