Providers and Patients File Class Action Against Insurance Companies for Failure to Pay COVID-19-Related Claims

A group of healthcare providers and individual plaintiffs have filed a class action lawsuit against UnitedHealthcare Inc., OptumHealth Care Solutions, and various other defendants in a Florida federal district court. The providers received an assignment of benefits from the defendants for COVID-19 testing that they have provided and continue to provide to beneficiaries of the defendants’ plans and their family members.

More than 34,000 claims for COVID-19 tests and related services are reportedly pending. The insurance companies continued to post profits during the COVID-19 pandemic when so many businesses saw losses. For instance, UnitedHealth boasted increased profits of almost 12% in 2021, reaching $17.3 billion.

The proposed class members allege that the defendant insurance companies have consistently delayed and avoided paying for COVID-19-related services. In their suit, the class members claim that the insurance companies’ failure to reimburse providers for the claims violates various laws, including the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Employee Retirement Income Security Act (ERISA), and the Class Action Fairness Act (CAFA).

The plaintiffs further claim that the providers largely paid for claims up submitted until June 2020. After that date, the insurance companies have allegedly systematically denied or underpaid claims and made it impossible to appeal the denials.

Proposed class members may include tens of thousands of people. Included in the proposed class are “insureds, participants or beneficiaries in any group or individual health insurance plan issued, underwritten or administered by one or more of the defendants who were denied health insurance coverage for COVID-19, or paid or were required to pay for testing, between March 2020 to the present.”

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.

The following two tabs change content below.

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.

Latest posts by Hall Benefits Law, LLC (see all)