National medical group files lawsuit, urging health insurer to pay its bills and fairly reimburse clinicians providing life-saving emergency care to patients across the country
NASHVILLE, Tenn. — Envision Healthcare, a leading national medical group, filed suit against UnitedHealthcare Services, Inc. and UnitedHealthcare Insurance Company (“United”) in U.S. federal court in Tennessee. The suit claims that United puts profits above all else, including patients and the physicians and advanced practice providers who provide life-saving care in emergency rooms across the country.
“After pushing Envision clinicians out-of-network in January 2021, United began a routine and systematic denial of commercial claims related to emergency room care for its members with the highest acuity — patients who sought care for life-threatening illnesses and complications,” said Jim Rechtin, Envision Healthcare CEO. “United’s scheme to deny patient claims violates federal law. Improperly withholding payment from the very frontline clinicians who treated their members in their most acute time of need is, in my opinion, cold, callous and inhumane.”
The lawsuit highlights several instances, including a 31-year-old man requiring an emergency appendectomy and a 2-month-old baby with unexplained episodes of choking, vomiting and turning blue, in which United subjected claims to a “pre-payment review” and then ultimately denied the claim. For Envision’s clinicians, these patients represent why our clinicians do what they do every day — it is why emergency rooms exist and why our government ensures that by law patients have access to those emergency rooms. For United, it was an opportunity to deny payment. United did not pay a penny for the emergency, life-saving treatment provided to either patient.
“Envision clinicians care for 30 million patients every year. United’s policy of systematically denying commercial claims for high-acuity care impacts the hardworking clinicians treating United’s members in the emergency department every day,” Rechtin continued. “No other health plan comes close to the level of denials we see from United. United needs to be held accountable for not fulfilling its basic function – paying for care. United needs to pay its bills.”
Before being pushed out of its network, United denied approximately 18% of commercial claims submitted by Envision. That number spiked in November 2021 to approximately 48% of all submitted claims. For the highest-acuity care claims, United callously and automatically denied approximately 60% of commercial claims.
“Only United, with its $17.3 billion in profits in 2021 and 1,000% stock price increase for its owners, would have the audacity to refuse reimbursement to the clinicians providing the life-saving care to its own members,” Rechtin added. “Envision’s clinicians will continue to guide their patients through life’s toughest moments. Fighting for their patients’ lives should not include fighting to get paid.”
About Envision Healthcare Corporation
Envision Healthcare Corporation is a leading national medical group that delivers physician and advanced practice provider services, primarily in the areas of emergency and hospitalist medicine, anesthesiology, radiology/teleradiology, and neonatology to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. Post-acute care is delivered through an array of clinical professionals and integrated technologies which, when combined, contribute to efficient and effective population health management strategies. As a leader in ambulatory surgical care, AMSURG holds ownership in more than 250 surgery centers in 34 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. In total, the medical group offers a differentiated suite of clinical solutions on a national scale with a local understanding of our communities, creating value for health systems, payers, providers, and patients. For additional information, visit www.envisionhealth.com.