UnitedHealthcare ‘Refused to Reimburse’ Health Insurance Claims for Anesthesia Services, Class Action Alleges

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UnitedHealthcare Anesthesia Reimbursement Class Action Lawsuit Overview:

• Who: North Carolina residents have lodged a class action lawsuit against UnitedHealthcare Insurance Company.
• Why: UnitedHealthcare allegedly violated its health benefit policies by refusing to reimburse patients and providers for anesthesia services.
• Where: The lawsuit is pending in North Carolina federal court.

Patients who needed anesthesia and had it administered by a particular provider say health insurance company, UnitedHealthcare, has refused to reimburse them for the costs, a new class action lawsuit alleges.

Seven North Carolina residents who have had health insurance provided by UnitedHealthcare Insurance Company are now suing the company. The plaintiffs, Cynthia Pusey Vigdor, Robert Vigdor, Vanessa Krombeen, Vashista Kokkirala, Jessica Huck, Richard Smithson, and Ronald Easter, accuse the health insurance company of violating state and federal law.

On Wednesday, the class action lawsuit — originally filed Aug. 16 — was moved to federal court.

UnitedHealthcare Refuses Claims from Patients, Providers

In their lawsuit, the patient plaintiffs allege they had anesthesia services provided by Providence Anesthesiology Associates, an anesthesia provider that was in UnitedHealthcare’s network until March 2020. 

The plaintiffs claim that, despite having health insurance coverage through UnitedHealthcare, they received balance-bills from Providence for out-of-network services. UnitedHealthcare has “refused to reimburse” them, they say. 

The plaintiffs allege that the procedures they undertook were covered under their medical insurance plans with United, however the provider has “refused to pay any of their bills.” 

Providence has also joined the class action lawsuit as a plaintiff to recover the missing funds. 

It says it has “obtained assignment of benefit forms or the right to receive payment from the patient plaintiffs” and that these forms “grant Providence the right to take any actions necessary to recover payments from United for covered services under the patient’s plans.” 

The class action is suing under the Employee Retirement Income Security Act of 1974, and for violation of North Carolina’s Unfair and Deceptive Trade Practices Act and breach of contract.

It says at least one of the applicable health benefit plans is an employer-sponsored welfare benefit plan. 

This is not the first time the insurance provider has been sued for underpaying benefits. 

In 2010, UnitedHealthcare settled a class action lawsuit for $350 million after being accused of issuing inadequate reimbursements to its members for covered services provided by out-of-network providers using Ingenix databases.

Do you have health insurance with UnitedHealthcare? Let us know your experience in the comments! 

The plaintiffs are represented by Emily C. McGowan and Matthew P. McGuire of Alston & Bird LLP

The UnitedHealthcare Anesthesiology Claims Class Action Lawsuit is Vigdor et al., v. UnitedHealthCare Insurance et al., Case No. 3:21-cv-00517-GCM-DCK, in the U.S. District Court for the Western District of North Carolina Charlotte Division.

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