United Healthcare and three Georgia medical providers — Hospital Physician Services Southeast PC, InPhyNet Primary Care Physicians Southeast PC and Redmond Anesthesia & Pain Treatment PC — have settled a dispute over reimbursements for out-of-network claims. A Georgia federal court judge closed the case after United informed him of the settlement with undisclosed terms. The case is United Healthcare Services Inc. et al. v. Hospital Physician Services Southeast PC et al., Case Number 1:23-cv-05221, U.S. District Court for the Northern District of Georgia.
United originally sued the medical providers in November 2023, accusing them of overcharging individuals enrolled in employer-sponsored healthcare plans for out-of-network services. Although United reimbursed the providers at plan rates and methodologies, the providers were dissatisfied with those amounts. The providers claimed they were entitled to higher charges that they allegedly settled upon unilaterally. In response, United argued that benefits in plans governed by the Employee Retirement Income Security Act (ERISA) must follow plan terms, thus preempting any claims providers made for full reimbursement of their billed charges.
The providers moved to dismiss the suit, pointing out that they hadn’t sought full reimbursement for the claims from United. Unlike other entities affiliated with collection agency TeamHealth Holdings, Inc., which have pursued United for out-of-work emergency services, these providers, despite their affiliation with TeamHealth, have not. Moreover, if they did seek additional reimbursement, the providers claimed, they would utilize the federal dispute resolution laid out in the No Surprises Act (NSA) for hospital-based services.
United’s suit focused on only pre-NSA claims and claims ineligible for NSA dispute resolution. The providers stated that they had waived any pre-NSA claims and do not staff any Georgia hospitals that are out-of-network with United.
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