Did United Use Phony Excuses and Delay Tactics to Avoid Lap-Band Payments?
Complaint claims insurer is targeting the morbidly obese.
Published: March 26, 2014
United Healthcare is the target of a federal lawsuit accusing the insurance giant of discriminating against morbidly obese patients by means of a "deliberate, willful and concerted effort" to deny payments for authorized lap-band surgeries.
The complaint, which was filed in Los Angeles by L.A.-based surgical centers and physicians and which also names hundreds of employer-funded health plans, alleges that United has engaged in a variety of stalling tactics, including:
- repeatedly and redundantly requesting unspecified medical records, including records that have already been provided;
- forwarding claims for further review to a wholly-owned subsidiary in the Philippines and promising the reviews will take 15 to 30 days, when in fact they've taken years and still resulted in no payment;
- claiming that facilities aren't listed in its database of providers, despite having paid those facilities (and surgeons) in the past;
- demanding surgery center licenses, despite the fact that California doesn't license surgery centers; and
- wrongfully denying valid claims on the basis of pre-existing conditions.
"This is a classic case of an insurance company putting profits over people," says Daron Tooch of the Los Angeles law firm Hooper, Lundy & Bookman, which filed the case on behalf of the surgical centers.
The plaintiffs claim that United has authorized hundreds of preoperative tests for patients, then refused to pay for the tests despite the fact that patients qualified for the surgery. United has also refused to pay for post-surgery adjustments, according to the suit, leaving many patients unable to afford or receive the care they need and to which they're entitled.
In an e-mailed statement, a United spokesperson wrote, "We are currently reviewing the complaint that was filed with the court on March 20th and will determine the appropriate legal response to this lawsuit. This same law firm attempted to take similar legal action against us on behalf of several patients who received services from 1-800 GET THIN affiliated providers and those suits were all dismissed by the court. It has been reported that 1-800-GET-THIN affiliated providers are under federal investigation for health care fraud."
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