Have You Been Negatively Affected by United Healthcare/Optum Practices?
Category: Insurance News
Oct
13
ACA-led legal action granted class standing; providers asked to step forward with proof of UHC/Optum's inappropriate practices
The American Chiropractic Association (ACA) seeks information from doctors of chiropractic regarding improper practices used by United Healthcare/Optum to recoup payments and to limit amount of care authorized.
UHC stands accused in federal court by ACA and other provider groups of retroactively reducing the amount of money owed to providers as reimbursement for incurred expenses and violating ERISA regulations by offsetting claims of other patients to recoup alleged overpayments.
On Aug. 28, the court granted class standing, which not only allows providers who are not within United's network of providers to seek relief on a class-wide basis, but also endorses the applicability of ERISA's regulations to UHC/Optum's requests for repayment.
"Our lawsuit alleges a long history of intimidation and coercion of patients and providers. Anyone who has current information that provides evidence of such practices should contact ACA immediately," stated ACA President Anthony Hamm, DC.
At this time, ACA would like to speak with providers who: Are out-of-network, and have previously received a recoupment notice or an offset (where funds owed to United were withheld from other patients' claims), or Are in- or out-of-network experiencing the following types of abusive practices alleged in the case:
The American Chiropractic Association (ACA) seeks information from doctors of chiropractic regarding improper practices used by United Healthcare/Optum to recoup payments and to limit amount of care authorized.
UHC stands accused in federal court by ACA and other provider groups of retroactively reducing the amount of money owed to providers as reimbursement for incurred expenses and violating ERISA regulations by offsetting claims of other patients to recoup alleged overpayments.
On Aug. 28, the court granted class standing, which not only allows providers who are not within United's network of providers to seek relief on a class-wide basis, but also endorses the applicability of ERISA's regulations to UHC/Optum's requests for repayment.
"Our lawsuit alleges a long history of intimidation and coercion of patients and providers. Anyone who has current information that provides evidence of such practices should contact ACA immediately," stated ACA President Anthony Hamm, DC.
At this time, ACA would like to speak with providers who: Are out-of-network, and have previously received a recoupment notice or an offset (where funds owed to United were withheld from other patients' claims), or Are in- or out-of-network experiencing the following types of abusive practices alleged in the case:
- Use of policies that improperly reduce coverage for chiropractic services
- Refusal to allow providers to request a particular number of visits or procedures, or to submit clinical information necessary for utilization review
- Subjection of providers to threatening communications in an effort to coerce reduced utilization rates
- Reliance on statistically invalid data to determine average utilization benchmarks (inappropriate profiling and tiering), and/or
- Appeal rights not consistently afforded to patients when the care authorized differs from the doctor's care plan.
- By email at [email protected]
- By fax at (866) 575-8615
- By phone at (703) 812-0225 - Due to the numbers of providers calling, please leave your name, phone number, and best time/day to call. We will contact you usually within one to two business days.
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