It’s no secret that UnitedHealthcare is reducing provider networks across the nation while boosting its record-setting profits.
And another company is fighting back: Envision Healthcare in Broward County, FL, filed a lawsuit against UnitedHealthcare in May, claiming UnitedHealthcare is scheming to underpay front-line healthcare providers and push them out-of-network. An article in Becker’s Hospital Review says that Envision is seeking to recover millions of dollars in alleged underpayments for medical care it provided to UnitedHealth members.
Excerpts from the Envision lawsuit shine a light on how UnitedHealthcare allegedly operates:
United, the country's largest commercial health insurance company, engages in a nationwide pattern and practice of intentionally underpaying frontline healthcare providers to boost its profits. United's scheme is simple: issue drastically reduced "take it or leave it" reimbursement rates during contract negotiations to force providers out of its networks, rather than pay them fair and reasonable rates for their services, including saving lives during an unprecedented pandemic.
Once United successfully forces a provider out of network, United then intentionally and significantly underpays the now "out-of-network" provider, often at rates even lower than the contract rates offered. United then lines its pockets with the money that providers have worked tirelessly to earn, money the providers deserve.”
This model is not limiited to United Health Group, nor is it a recent phenomenon.Every major health insurance plan has implemented this methodology against providers and institutions.It has been an ongoing model for two decades at the inception of preferred provider groups in the 1990s. At the same time health insurance premiums, deductibles, and copayments have increased. The victims are the patients using providers as the weapon. In Georgia it has reached the judicial level of adversarial contracting.
One lawsuit in one state may set a small precedent against the huge health insurance lobby.
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