Becker's Source Article | Comments Courtesy of Matt Zavadsky

This might be something to keep in our quiver as discussions continue on surprise payments.

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Former UnitedHealth exec says company would only pay surprise bills after complaints

November 12th, 2021

Nick Moran

The former head of UnitedHealthcare's Shared Savings Program alleged during testimony that the insurer was willing to pay for its members' surprise medical bills, but only if they filed a complaint to the company.

 

The testimony is part of the ongoing legal battles between UnitedHealthcare and TeamHealth. John Haben, the former UnitedHealthcare executive, has been testifying in Nevada over a TeamHealth lawsuit that alleges the insurer's Shared Savings Program resulted in millions of dollars in clinician underpayments.

 

During his testimony, Mr. Haben told prosecutors that UnitedHealthcare's explanation of benefits told members they could raise questions about reimbursement but did not explicitly say UnitedHealthcare would pay for surprise bills, according to a Nov. 11 news release.

 

He also claimed that UnitedHealthcare undercut providers through the program, paying them as little as 20 percent of billed charges.

 

A UnitedHealthcare spokesperson told Becker's that TeamHealth's lawsuit doesn't hold any weight but that it does serve as a distraction against TeamHealth's decision to leave the insurer's provider network.

 

"This lawsuit is meritless and is just another example of TeamHealth’s efforts to distract from the real reason it no longer participates in our network, which is their unreasonable demands that they be paid double or even triple the median rate we pay other physicians providing the same services," the UnitedHealthcare spokesperson told Becker's. "We are committed to addressing these unreasonable and anticompetitive rates that many private equity-backed physician staffing companies charge for services, which drive up the cost of care for our customers, members and the health care system."

 

TeamHealth contested the claims in UnitedHealthcare's statement, pointing to one instance mentioned in court where the insurer allegedly reimbursed $254 for a gunshot wound treatment billed at $1,428, despite Mr. Haben calling the full price tag "worth" the charge.

 

“UnitedHealthcare's goal has been to reap larger profits at the expense of frontline healthcare providers and their patients," the TeamHealth spokesperson told Becker's. "In the Nevada courtroom, TeamHealth is proving that United orchestrated a scheme to artificially and fraudulently reduce payments to physicians."