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Legal Update - 10.21.15
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United Healthcare:

We have no real update at this time but if providers are still having issues with UHC taking money out of EOB’s please contact our office.



Our legal team had a court date on October 14th to argue our case in front of a judge.  Here is an excerpt from our litigating attorney on his impression of the trial:


“We were very encouraged by the Court’s response to our argument. Highlights include Judge Jeffrey Sutton’s comment that the CMS interpretation “capping” reimbursement to non-contracted providers under Medicare Part C is “egregiously flawed,” as well as the Court’s description of Humana’s recoupment activity as “self-help” that is not sanctioned under Medicare law.


After briefing is concluded, we will likely have to wait a few months before a decision is issued. Until then, please feel free to contact us with any questions or concerns. This is a very important case, and it has attracted national attention especially from large insurance companies and associations that represent them (for example, America’s Health Insurance Plans filed an amicus brief in this case supporting Humana). A favorable decision would be a huge victory affirming the rights of providers challenging arbitrary fundamentally unfair actions by insurance companies.”


We will now simply wait and see what the court rules.  We will update the membership once we have more info.


If you are still having issues with Humana taking monies it is important that you appeal this decision.



We have received a response to our letter. OPTUM stands by their position and argues that we have no argument.  We are scheduling another call with them to try one last effort to stop this action from taking place.  Our legal team says it is unlikely we will be able to stop this implementation but we will try everything we can.


We will keep our members informed as we know more.

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