By now most physicians are aware of the class action lawsuit brought against UHC and its subsidiaries by the AMA and other plaintiffs. The lawsuit alleges that UHC provided insufficient reimbursement for covered out of network (OON) services by:
- using flawed databases developed by Ingenix in determining reimbursement amounts for covered OON health benefits;
- using the OON reimbursement policies to reduce reimbursement amounts improperly for covered OON health benefits; and
- inadequately disclosing the use of the Ingenix databases and their OON reimbursement policies in determining reimbursement amounts for covered OON health benefits.
The most important thing to understand about this lawsuit is that it applies only to non-contracted providers, as only they could have provided out of network (OON) services. Since the vast majority of PDS clients are contracted providers with UHC, this class action settlement does not apply to you. For more information on this and other payer-related class action lawsuits, click here.