United Healthcare Offers ‘Unreasonable,’ ‘Arbitrary,’ Reimbursements To Surgical Assists

United Healthcare & Class Action Lawsuit
(Photo Credit: Katherine Welles/Shutterstock)

United ERISA Under Reimbursement Class Action Lawsuit Overview: 

  • Who: Robert I. Ellis filed a class action lawsuit against United Healthcare Insurance Company and one of its vendors, Data iSight.
  • Why: Ellis claims United intentionally under reimburse Surgical Assists who perform procedures on patients covered by their health plans or by plans contracted under the Employee Retirement Income Security Act of 1974.
  • Where: The class action lawsuit was filed in Texas federal court.

United Healthcare Insurance offers “unreasonable” and “arbitrary” reimbursements to Surgical Assists (SAs) who perform procedures on policyholders and consumers who are fully insured with employee welfare benefit plans. 

Plaintiff Robert Ellis argues United uses an “arbitrary methodology” to under reimburse SAs, and that plans which contract with United as covered by the Employee Retirement Income Security Act of 1974 (ERISA) are aware of its shady practices. 

Ellis wants to represent a Class of SAs who were not appropriately compensated after performing procedures in the state of Texas on patients insured by United under plans governed by ERISA. 

Ellis — an SA — claims United “systematically and drastically underpriced and underpaid” for services provided by him and other SA’s like him. 

“SA’s all across the state of Texas, including Plaintiffs, have been harmed by the Defendants’ failure to properly pay for SA services that were provided to the Defendants’ members,” states the class action lawsuit. 

United works with its vendor, Data iSight, to maintain records of “when and how it receives, processes, pays, or refuses to pay claims for surgical assist services,” according to the class action lawsuit. 

Ellis claims, however, that the methods used by United and Data iSight to calculate how much to pay SAs for out-of-network benefit payments is an “abuse of their discretion and fiduciary duties.”

“By using arbitrary and inappropriate methodologies to price and pay Plaintiffs’ out-of-network, the Defendants have systematically and drastically underpriced and underpaid Plaintiffs for their services,” the class action lawsuit states. 

Ellis argues that not only do SAs have to incur expenses by not being properly reimbursed, but they then suffer even more direct harm by “having to attempt to collect amounts from members that the members justifiably believe should be covered by their health benefit plans.”

Health plan members are also falsely led to believe they have the freedom to choose an out-of-network provider who will be appropriately reimbursed, the class action lawsuit alleges. 

Ellis claims United and Data iSight have committed multiple ERISA violations. He is demanding a jury trial and requesting relief in the form of past due benefits, with interest, for himself and all Class Members.

Ellis is also asking that United be required to “pay future Plaintiffs’ benefit claims using an appropriate methodology.” 

A separate class action lawsuit was filed against United earlier this year by patients claiming the company refused to reimburse them or their providers after anesthesia services

Have you been under reimbursed by United following a procedure you performed on a patient covered directly by the insurer or a contracted ERISA plan? Let us know in the comments! 

The plaintiff is represented by Timothy Micah Dortch, Derek H. Potts, and Christopher D. Lindstrom of Potts Law Firm, LLP. 

The United ERISA Under Reimbursement Class Action Lawsuit is Ellis v. United Healthcare Insurance Company, et al., Case No. 4:21-cv-00923, in the U.S. District Court for the Northern District of California.

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