Important Information on the United Healthcare Settlement on Out of Network Payments

As reported previously, the settlement entered into by United Healthcare (UHC) is subject to preliminary approval by a federal district court in New York.  No distribution of the settlement fund can take place until final court approval has been obtained following a "fairness" hearing.  Details of the settlement and formal notice will be provided to affected members of the subscriber and the healthcare provider classes.

However, physician should be aware that the initial lawsuit against UHC (and others) with regard to improper out of network payments to physicians and patients was brought on March 15, 2000.

If the Judge in the pending fairness hearing rules that class actions can go forward, the Class Period, accordingly, will begin on March 15, 1994.

It is important to note that there are NO FORMAL rulings or instructions at this point so how physicians will be able to participate in any class actions is still up in the air.

However, if your practice still has any records or claims relating to providing out-of-network services on an assignment basis from March 15, 1994 to the present to UHC members, DO NOT DISCARD THEM.

Hold on to them in the event that class actions go forward as you will need to show that you provided the service on an assignment basis.

Organized medicine’s attorneys are proposing simple rules as possible for a doctor to show that he/she had an assignment. For example, if the doctor received payment directly from United, that should be deemed to be an assignment.

Please note that this process is expected to take a long time. As more information is received on this issue, you will be apprised through the regular communication channels. Or, for guidance, contact us through the Third Party Insurance Help Program.