The U.S. Department of Labor is alleging UnitedHealth Group denied thousands of patients' payments for emergency room services and urinary drug screenings.
The lawsuit states that UMR, a third-party administrator and UnitedHealth subsidiary, denied claims based on diagnosis codes and failed to abide by requirements of the Affordable Care Act (ACA) and Labor Department’s claims procedures regulation.
UMR denied all urinary drug screenings from August 2015 to August 2018, when it should have determined whether a claim was medically necessary, which violated the Employee Retirement Income Security Act (ERISA), the lawsuit further alleges. From August 2018 to the present, UMR allowed some urinary screenings if it was done in an emergency setting but changed its denial code again in October 2019. Explanation of benefits did not comply with the ACA.
UnitedHealth Group had not responded to a request for comment at press time.
The lawsuit says that UMR changed its urinary drug screening process in August 2018 because 98% of those claims were overturned upon appeal.
https://www.fiercehealthcare.com/payers/unitedhealth-sued-us-labor-department-over-claims-denials
The lawsuit states that UMR, a third-party administrator and UnitedHealth subsidiary, denied claims based on diagnosis codes and failed to abide by requirements of the Affordable Care Act (ACA) and Labor Department’s claims procedures regulation.
UMR denied all urinary drug screenings from August 2015 to August 2018, when it should have determined whether a claim was medically necessary, which violated the Employee Retirement Income Security Act (ERISA), the lawsuit further alleges. From August 2018 to the present, UMR allowed some urinary screenings if it was done in an emergency setting but changed its denial code again in October 2019. Explanation of benefits did not comply with the ACA.
UnitedHealth Group had not responded to a request for comment at press time.
The lawsuit says that UMR changed its urinary drug screening process in August 2018 because 98% of those claims were overturned upon appeal.
https://www.fiercehealthcare.com/payers/unitedhealth-sued-us-labor-department-over-claims-denials
