Envision sues UnitedHealthcare over allegedly denied ER claims

Envision Healthcare, a national physician staffing firm, said it is suing UnitedHealthcare, one of the nation’s largest insurers, for denying payment for emergency services the medical group provided.

Envision CEO Jim Rechtin alleges UnitedHealthcare routinely denied claims for commercial members who were among the sickest and sought care at an emergency room. Rechtin called UnitedHealth’s alleged practice “cold, callous and inhumane,” according to a statement released Friday announcing a lawsuit was filed in a Tennessee federal court.

UnitedHealthcare denied payment for a 31-year-old man’s emergency appendectomy and care for a baby with unexplained episodes of choking, vomiting and turning blue, Envision alleges.

A spokesperson from UnitedHealthcare said the company is still reviewing the filing.

Last year, UnitedHealthcare cut Envision’s 25,000 clinicians from its network. The insurer said the staffing firm wanted to be paid twice the median rate of other anesthesiologists and more than triple the median rate of other ER physicians, according to Healthcare Dive’s earlier reporting.

Prior to being pushed out of the network, Envision alleges UnitedHealthcare denied 18% of all the commercial claims it submitted. The number of denied claims increased to 48% just months before Envision was out-of-network.

For the sickest patients, or those with the highest-acuity, United denied 60% of commercial claims, Envision alleges, according to the statement.

Another physician staffing firm is also suing United over denied payment for emergency services.

In July, TeamHealth filed suit alleging the insurer wrongly denied and underpaid for services its emergency physicians provided to patients in Nevada.

The lawsuit alleges that UnitedHealthcare did not pay the Nevada physicians after treating an infant with a traumatic brain injury and a child with a ruptured appendix.

The lawsuits come amid a changing regulatory environment for payment disputes between payers and providers.

A federal law took effect earlier this year that protects patients from being on the hook for surprise medical bills.

Patients can find themselves unknowingly treated by an out-of-network physician even at an in-network facility. When this happens, insurers typically pay a portion of the out-of-network bill, leaving patients to pay the balance, which can be costly. The federal law bars patients from having to pay these bills in most instances.

A prior study from researchers at Yale University has shown that staffing firms use out-of-network billing as a strategy to ultimately increase payments.

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