While the brazen murder of UnitedHealthcare CEO Brian Thompson evoked sympathy in some, it also gave voice to public complaints about the health insurance company’s wrongful denial of claims. Hospitals and other medical providers have recently filed several lawsuits against UnitedHealthcare over nonpayment of claims. As news of the recent murder retreats from the headlines with the capture of a suspect by law enforcement, it is unlikely to affect the ongoing lawsuits.
In response to the backlash of dissatisfied customers, the insurance industry initially showed signs of softening its harsh stance on denying claims. For instance, Anthem Blue Cross Blue Shield announced that it would limit coverage for anesthesia during surgery and other medical procedures in certain states. The resulting criticism by doctors, patients, and politicians resulted in Anthem hastily withdrawing its new policy.
However, the industry’s initial reaction is not likely to last, as health insurance companies have reimbursement policies with medical providers that insulate them from criticism. As health insurance companies continue to find ways to cut costs and increase profits, they are likely to implement similar policies that decrease coverage for customers.
Likewise, UnitedHealthcare and other insurance companies are unlikely to change their approach to litigation over nonpayment with medical providers. Insurers are accustomed to criticism by the public and continue to operate as for-profit entities focused on profits, not popularity.
UnitedHealthcare and its parent company, UnitedHealth, recently removed at least 12 pending cases from state to federal court. The lawsuits, filed in Alabama, New Jersey, and New York, all stem from the company’s alleged lack of reimbursement for services.
The two lawsuits in Alabama relate to UnitedHealthcare’s alleged failure to reimburse hospitals at the allowable rate for drugs administered to patients on Medicare. The plaintiffs claim that UnitedHealthcare violates the U.S. Supreme Court’s 2022 decision in American Hospital Association v. Becerra. In that case, the Court ruled that a specific policy reducing certain drug reimbursements violates the Medicare Act.
In the seven New Jersey cases, an out-of-network surgery center alleges that UnitedHealthcare violated an agreement to reimburse it at the in-network rate for breast reconstruction surgery for women who had mastectomies due to breast cancer.
Finally, a New York neurologist has three pending cases concerning services he provided after UnitedHealthcare reportedly promised reimbursement based on the billed charges or another agreed-upon amount. The agreement aimed to ensure the patient would be held harmless for any remaining amounts. The neurologist claims that the insurance company did not uphold the agreement.
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