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TeamHealth and UnitedHealthcare get in the ring . . . again

It’s the Groundhog Day of health insurance lawsuits in the state of Nevada. Will TeamHealth come out on top again?

Does a Nevada lawsuit with UnitedHealthcare (United) sounds familiar? Well, since TeamHealth filed ten lawsuits against UnitedHealth Group last December, alleging underpayment for TeamHealth physicians – it might!

In the first case, a small victory – the Las Vegas jury found United guilty. But now, we’re feeling some déjà vu. According to a July 14 article in Healthcare Dive, TeamHealth is dragging United back to court, alleging again that the insurer is wrongly denying coverage and underpaying for the emergency physicians’ company’s services.

And if all this sounds like legal mumbo jumbo, maybe this will paint a clearer picture:

According to the article, “The lawsuit alleges that UnitedHealthcare did not pay the Fremont physicians after treating an infant with a traumatic brain injury and a child with a ruptured appendix.”

Yes, you read that right. United is accused of denying care for young children in serious, emergency situations. Allegedly, United “uses an algorithm to routinely delay and deny claims based on certain diagnosis codes.”

These algorithms can be efficient, but they aren’t always accurate. Just think how often Facebook and Netflix algorithms suggest content for you that misses the mark. Now consider insurance companies using similar algorithms to determine whether care is needed or not; they’re bound to make mistakes.

TeamHealth subsidiary Fremont Emergency Services is alleging that the nation’s largest private insurer’s actions violate federal law. As a result, they are asking for a permanent injunction to stop UnitedHealthcare’s policy, which automatically and arbitrarily downcodes treatment, ultimately reducing payments to clinicians who provided life-saving care.

In the first case last December, United had to pay out $60 million in damages…and then turned around and sued TeamHealth back. Will they continue to play legal games with patients’ health, or just pay up for the care their members receive?

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