Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...
June 29 — A Dallas-area hospital that sued United HealthCare Services Inc. for more than $104 million in unpaid and underpaid medical bills stated viable claims against the insurer, a federal judge ruled ( Tex. Gen. Hosp., LP v. United Healthcare Servs., Inc. , 2016 BL 208258, N.D. Tex., No. 3:15-CV-02096-M, 6/28/16 ).
Texas General Hospital, an acute care facility outside United's provider network, accused the insurer of “drastically underpaying” and refusing to pay for medical care provided to United-insured patients. A federal judge on June 28 largely denied the insurer's motion to dismiss the lawsuit, allowing Texas General to move forward with claims for benefits and other relief under the Employee Retirement Income Security Act.
In particular, Chief Judge Barbara M.G. Lynn of the U.S. District Court for the Northern District of Texas allowed the hospital to sue United in federal court without first exhausting the insurer's internal appeals procedures for all 1,969 patients in question.
That's because the hospital sufficiently showed that United failed to provide “meaningful access” to its appeals procedures and that further efforts would be futile, Lynn said.
Lynn also allowed the hospital to move forward with certain state law claims related to non-ERISA plans, along with claims that United violated ERISA by failing to fully and fairly review the hospital's claims.
However, Lynn dismissed Texas General's claim for alleged breach of ERISA's fiduciary duties. She explained that the benefit assignment forms Texas General received from its United-insured patients didn't give the hospital standing to pursue this claim.
K&L Gates LLP represents the hospital. Figari & Davenport LLP and O'Melveny & Myers represents United HealthCare.
To contact the reporter on this story: Jacklyn Wille in Washington at email@example.com
To contact the editor responsible for this story: Jo-el J. Meyer at firstname.lastname@example.org
Text of the decision is at http://www.bloomberglaw.com/public/document/TEXAS_GENERAL_HOSPITAL_LP_and_TEXAS_GENERAL_GP_LLC_Plaintiffs_v_U.
Copyright © 2016 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)