Case Details for "UnitedHealth Group "

UnitedHealth Group pays $350 million to settle a lawsuit over out-of-network medical claims

Managed-care company UnitedHealth Group will pay $350 million to settle a lawsuit over out-of-network medical claims. The deal comes two days after the insurer pledged $50 million to set up a new database to determine payments for those claims. Another health insurer, Hartford, Conn.-based Aetna Inc., also agreed to pay $20 million toward the creation of that database. Both the lawsuit settlement and the new database center on much-criticized databases operated by UnitedHealth subsidiary Ingenix Inc.  Insurers contribute claims information to the Ingenix databases, and then they use those numbers to determine their "usual and customary" payment rates for care patients seek outside their insurance network.  But the class-action lawsuit alleged that insurers lowered the data they contributed, which then helped them lower their payment obligations. Doctors or other providers often billed patients for the difference.

Plaintiffs in the case, which dates back to 2000, included the American Medical Association as well as patients and health care providers. The $350 million UHG agreed to pay will fund a settlement for health plan members and care providers in connection with claims dating back to 1994.

A separate investigation by the New York Attorney General's Office found that insurers using Ingenix figures underpaid anywhere from 10 percent to 28 percent for certain out-of-network claims in New York state. UnitedHealth said it will close the databases and help fund the creation of a new one to be operated by a nonprofit organization. Aetna announced it will chip in, too.The new database, which could be running in six months, will include a Web site that allows patients to learn in advance how much they may be reimbursed for common out-of-network services in their area.  The trade association America's Health Insurance Plans has said this transparency could shed light on "one of the root causes" of rising medical costs: provider charges for out-of-network procedures that vary widely across the country.

Posted on:2009-01-15
Company: UnitedHealth Group
Class: unknown
Scope: Nationwide
Type of Case: Consumer
Settlement Administrator:

Contact Us Regarding This Settlement:

First Name
Last Name
Email Address
Phone Number
State of Residence	Please select Outside of US or Canada Canada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Name of Company At Issue
Description / Explanation
Security Code Please enter the code provided in the text box to submit this form.