Court grants class standing to out-of-network providers in UHC/Optum lawsuit

DCs subjected to UHC/Optum’s improper practices should contact ACA with information

September 11, 2014 — The federal court presiding over pending action against United Healthcare (UHC)/Optum for inappropriate repayment demands will now allow providers, including doctors of chiropractic, who are outside of United’s network to seek relief on a class-wide basis.

UHC stands accused of retroactively reducing the amount of money owed to providers as reimbursement for incurred expenses. The court’s decision, filed Aug. 28, could impact hundreds of DCs who have been subject to inappropriate repayment demands and Optum’s punitive policies, which resulted in reduced coverage for chiropractic patients.

The court’s action also endorses the applicability of ERISA regulations to UHC/Optum’s requests for repayment. This is a landmark development in ACA’s goal of achieving significant reform of UHC/Optum practices.

The litigation against UHC was originally filed on Jan. 24, 2011. ACA joined the lawsuit in April 2011, adding a host of injurious practices perpetrated upon practitioners by Optum, United’s subsidiary.

“UHC/Optum has a long history of intimidating and coercing patients and providers,” ACA President Anthony Hamm, DC, said. “It is time for us to provide all data needed so that together the profession can challenge these practices.”

At this time, ACA requests the following:

1. All 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) should contact ACA immediately.

1. All providers, whether in- or out-of-network, should contact ACA immediately if they are experiencing the types of abusive practices alleged in the case (see below):

1. Use of policies that improperly reduce coverage for chiropractic services.

1. Refusal to allow providers to request a particular number of visits or procedures, or to submit clinical information necessary for utilization review.

1. Subjection of providers to threatening communications in an effort to coerce reduced utilization rates.

1. Reliance on statistically invalid data to determine average utilization benchmarks.

1. Appeal rights not consistently afforded to patients when the care authorized differs from the doctor’s care plan.

Contact ACA in three ways (attach backup information, if possible, to all emails and faxes):

• By email at: Insinfo@acatoday.org

• By fax at: 866-575-8615

• By phone at: 703-812-0225 — Due to the number of providers calling, please leave your name, phone number, and the best time/day to call. We will contact you usually within one to two business days.

To learn more about ACA’s insurance advocacy work, visit the Chiropractic Network Action Center, www.acatoday.org/CNAC, which provides helpful resources and the latest information regarding network concerns for providers and their patients.

Source: American Chiropractic Association