UnitedHealth savings class action lawsuit overview:
- Who: Alexandra Popovchak and Oscar Gonzalez filed a class action lawsuit against UnitedHealth Group Inc.
- Why: Popovchak and Gonzalez claim UnitedHealth has made billions of dollars by collecting a “savings fee” from healthcare plans using “phantom savings” the provider says it obtained for plan members.
- Where: The class action lawsuit was filed in New York federal court.
UnitedHealth Group collects a “savings fee” from healthcare plans that it calculates using “phantom savings” the provider claims to have obtained for plan members but that don’t actually exist, a new class action lawsuit alleges.
Plaintiffs Alexandra Popovchak and Oscar Gonzalez claim UnitedHealth Group “deliberately ignores” readily-available data for “competitive fees” when determining the amount of benefits due for covered services from out-of-network providers.
Popovchak and Gonzalez argue UnitedHealth bases its determinations for the amount of benefits due on “repricer data” that is “based on the deeply discounted rates insurance companies have paid for the service.”
UnitedHealth — which is accused along with its repricers of making billions of dollars from the alleged scheme — then “deems just a fraction of the out-of-network provider’s billed charge as eligible for reimbursement under the plan,” according to the UnitedHealth class action.
UnitedHealth unable to force out-of-network providers to accept discounted rate, class action says
The plaintiffs argue that, since UnitedHealth is not able to force out-of-network providers to accept their discounted rate as full payment, plan members are left “financially and legally liable for the unpaid portion of the provider’s bill.”
“United takes for itself as much as one-third of the difference between the provider’s billed charge and the discounted rate United determined to be ‘eligible’ for payment under the plan,” the UnitedHealth class action states.
The plaintiffs want to represent a nationwide class of participants and beneficiaries of a self-funded employer-sponsored health benefit plan affected by UnitedHealth’s alleged scheme.
UnitedHealth is accused of violating the Employee Retirement Income Security Act (ERISA). The plaintiffs are demanding a jury trial and requesting declaratory relief and for UnitedHealth to “make good” on any losses incurred by class members due to its alleged fiduciary breaches.
A separate class action lawsuit was filed against UnitedHealth in October 2021 by North Carolina residents arguing the provider refused to reimburse patients and providers for anesthesia services.
Do you have a healthcare plan administered by UnitedHealth? Let us know in the comments.
The plaintiffs are represented by D. Brian Hufford, Jason S. Cowart, Caroline E. Reynolds and Trillium Chang of Zuckerman Spaeder LLP, and Leslie Howard of Cohen Howard LLP.
The UnitedHealth savings class action lawsuit is Popovchak, et al. v. UnitedHealth Group Inc., et al., Case No. 1:22-cv-10756, in the U.S. District Court for the Southern District of New York.
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25 thoughts onUnitedHealth class action alleges company collects fee from phantom savings
Yes. I had UnitedHealth insurance and the amount they claim to pay out-of-network providers was far less than standard. The amount they pay in
-network providers was also substandard, making it an unattractive option for providers. The same was true for Aetna.
Please add me I have had UHC for nearly 2 years.
Can you please post how to join? I live in Texas and UHC isn’t processing some of my out of network claims for more than 6 months, then they “audit” the unaddressed claims that they’re holding using “Optum”, their UHC company, then denying the claims 6-7 months after receipt. The 1 claim they paid in full & timely, they denied 6-7 months after paying because their Optum company found the notes didn’t support the CPT code billed, even when they paid the rest of the 2022 claims in full with the same treatment and billing. To take back the money from the out of network, this was a “gap exception” provider used & UHC authorized due to a deficiency in providers in our area, UHC refused to pay the 2023 claims after they determine what was owed by subtracting all the money paid by that claim from the owed claims in the next calendar year (which should even be a different policy??) Even though our authorization letter says they gap provider would be treated as “in network”, they are using a Medicare or Medicaid? schedule to pay the claims. UHC is acting as a TPA (3rd party administrator) for the self insured plan & that’s how it’s ERISA. I think they denied these last 2 July 2022 claims in May 2023, without ever otherwise accepting or denying because I kept asking UHC about their class action lawsuit that I found on Google describing what they did to me too because it seems like retaliation. In 2022, they short paid; slow paid; reprocessed claims so the gap provider got 4-6 small checks until it equaled the full amount. They seem to use the :Family Engagement Center full of really nice people as a “buffer” to actually getting things done, getting correct or proper information. I have also been trying to get a “benefits exception” for almost 2 years now. I didn’t know what it was called, but described as an “expansion of coverage” for something medically necessary that has to be requested from the employer. The US Dept of Labor finally gave me the Plan Administrator’s name & address so I can send the request to them directly since UHC REFUSED to help me. Please contact me.
I get two to three’s phone calls a day
Yes I had united insurance which is terrible. Please email me information on joining this class action.
Deny stenosis surgery supported by MRI,cat,x-rays,emg, ablation ect.
Add me please.
My former employer put me into uniter healthcare Medicare supplemental insurance in January2020 when I turned 65. They have paid absolutely zero claims.I now have over $7000 in doctor bills. I have filed many grievances with no results. Please add me to this suit. Thank you.
please add
I am being denied and you can add me
Please add me! I’m have been denied and dealing with same case for over year!
I have been with United Healthcare for over 20 years. I have been denied on many claims for anesthesia and have had to pay 100% of the claims. The latest was just within the last few months. I told the doctor that the bills were not being paid, they said they use in-network anesthetists. Within a month after my procedure, I had another bill!
Have this insurance
ADD ME
I have UHC. I’m having difficulty with a claim for an out of network provider.