Billing / Fees / Insurance

News in Brief

Editorial Staff

UHC / Optum Class Action Progressing

The federal court overseeing the UnitedHealthcare / Optum class-action suit – initiated in 2011 by the Ohio State Chiropractic Association, representing a nationwide class of health care providers; and subsequently joined by the American Chiropractic Association and Congress of Chiropractic State Associations, among others – has granted class standing to out-of-network providers, including doctors of chiropractic.

"UHC / Optum has a long history of intimidating and coercing patients and providers," said Dr. Anthony Hamm, ACA president, in an association release announcing the court's decision. "It is time for us to provide all data needed so that together the profession can challenge these practices."

The class-action suit alleges numerous violations by the insurer and its subsidiary, including improper recoupment of payments for services provided to UHC subscribers. According to the suit, the insurer forcibly recouped payments when said payments could not be made immediately by withholding reimbursements from subsequent unrelated claims – in clear violation of the Employee Retirement Income Security Act (ERISA).

The ACA suggests that "all providers who are out-of-network, and [who] have previously received a recoupment notice or an offset (where funds owed to United were withheld from other patients' claims) should contact ACA immediately. ... All providers, whether in- or out-of-network, should contact ACA immediately if they are experiencing the types of abusive practices alleged in the case."

To learn more about the litigation against UHC / Optum, visit the ACA's Chiropractic Networks Action Center by clicking here.

November 2014
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