Skip to Content

UnitedHealthcare’s tactics aren’t so bright in the Sunshine State

Looks like UnitedHealthcare’s denial tactics have forced them to pay up, yet again, per a December 10 article in the Orlando Sentinel.

It’s time to roll out the insurer red carpet – straight to court!

According to an article in the Orlando Sentinel, UnitedHealthcare (United) recently shelled out more than $4.7 million to UF Health The Villages Hospital and UF Health Leesburg Hospital, both located in Florida, following a lawsuit alleging the insurer denied more than 1,000 claims.

The health plan contracted with the two hospitals to provide care to in-network members, but after members received care, United repeatedly tried to avoid paying, arguing that the care wasn’t medically necessary and refusing to pre-authorize necessary treatments.

Both sides brought in expert physicians to testify whether the care provided was “medically necessary.” And no surprise…the court sided with the doctors.

How many times will hospitals be forced to take United to court to uphold its end of contracts it willingly signs?! Does United like to take its chances when it comes to lawsuits, and just hope not everyone will sue them?

It’s possible, especially if the rewards outweigh the risks for the insurer.

For a company as big as United, the profits associated with restricting access just might outweigh the risks of a few lawsuits here and there. At least, until more hospitals and physicians realize that these aren’t one-off denials happening in good faith – these are widespread and potentially strategic.

Original Article:

Subscribe to Un-covered Essentials

Your payor relations plan is only as good as your knowledge of industry trends—stay informed with our bi-weekly newsletter.