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United Healthcare Underpayment Lawsuits

by Les Wilson

The City of Boca Raton needs Boca Regional to solve its chronic problem with the largest health insurance company in the nation: United Healthcare. The affect of the now 3 month lapse in coverage was illustrated in my recent article The Human Cost. The people who shared their stories are your friends and neighbors.

Do a search on “United Healthcare Lawsuits”. The results should alarm you. Words like “fraud” and “Bad Faith” abound. Are there lawsuits against other health insurance companies? Yes, there are, but UHC is in a league of its own. It’s also obvious that Boca Regional’s complaint of lowball payments by United Healthcare (UHC) to doctors and hospitals isn’t unique to Boca Raton. The press articles from other cities sound familiar and except for the names, the quotes from hospital and UHC spokespersons are practically the same.

Tennova hospitals
Five Hospitals … the same situation in Tennessee has been going on since February last year. Tennova is still out of network for UHC

Tragically, underpayment is only one of several schemes UHC is having to defend itself about in court; and in some cases, losing. But the hard truth is that there is a very real human cost to UHC short-paying doctors and hospitals; and it’s a local cost being paid by more than 17,500 Boca residents. But the contract lapse also injures Boca Raton as a place to live, work, learn and play.

Ask yourself, would you send your student to FAU with your employer UHC policy where the closest In-Network hospital is 30 minutes drive? Would you do business with a bank, contractor, store or real estate agent with search results like United Healthcare? Would you partner with someone with that reputation? Would you move to Delray instead? Geez.

The solution to Boca’s problem is going to have to come from the leadership of Baptist Health South Florida. They need to make Boca Regional sustainable.

AARP isn’t licensed to sell Health Insurance

And to make matters worse, litigation in Florida, and Connecticut alleges AARP’s exclusive marketing relationship with UHC is insurance fraud for “deceptive and unlawful scheme takes advantage of unsuspecting senior citizens.”; The very population AARP claims to help. In Texas, UHC is accused of bullying a small out-of-network laboratory services provider out of business.

The Texas filing reveals that United Healthcare is currently under investigation by the United States Department of Justice for perpetrating a decade-long, multi-billion dollar fraud that gamed the Medicare Advantage payment system. This is the Medicare Plan sold by UHC and marketed by AARP that dropped Boca Regional from it’s network midway through the year. But underpaying doctors and hospitals hurts patients too and a lawsuit in Pennsylvania stands to prove it resulted in inadequate care. See our case study “The United Healthcare Gap Provision is a myth“. It gets worse.

Excerpt from Texas lawsuit

The problem is widespread. The solution must be local.

Let’s be honest. Until there are wholesale cancellations by employers that shed UHC as IBM did, the local problem will not be solved for the roughly 20% of Boca Ratonians affected. It’s a vicious cycle. UHC refuses to pay enough and hospitals can’t survive if they take patients with UHC. The solution to Boca’s problem is going to have to come from the leadership of Baptist Health South Florida. They need to make Boca Regional sustainable. This year it’s UHC. Who knows what next year brings?

UHC and AARP subscribers should reward the hospital and team up with insurance policies that pay the freight. But employees (and their families) of companies with healthcare plans that don’t include Boca Regional are stuck. Who wants healthcare from someone who isn’t paid enough by your health insurance?

For more information:

This is the 7th article in our series on the impasse between United Healthcare and Boca Raton Regional Hospital. Previous articles:
1) Boca Raton Regional Hospital Fails its Strategic Vision When United Healthcare Drops it.
2) Baptist Health South Florida Heard You
3) Get the 411 on UHC at Boca Regional Before You Dial 911
4) When People Become Pawns
5) IBM Drops United Healthcare For 2020
6) The Human Cost

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