According to the release, overpayment demand is defined as an adverse benefit determination under federal ERISA law, which triggers an appeal process and a full and fair review within 180 days. BHSC alleges that UnitedHealth’s failure or refusal to comply with the appeal process was so prevalent that the surgery center had to initiate a class-action lawsuit.
Beverly Hills Surgical Center also alleged that UnitedHealth and OptumHealth failed to comply with ERISA regulations in denying pre-service and concurrent care claims from chiropractic providers. The plaintiffs’ counsel said that the defendants allegedly violated their ERISA obligations in order to recover funds that do not belong to them.
The first amended class complaint, filed April 22, expands an original lawsuit filed on Jan. 24 by adding additional class plaintiffs, additional defendants and additional complaints. The original action was filed on Jan. 24 on behalf of a group of chiropractors and the Ohio State Chiropractic Association.
Read the press release on UnitedHealth Group and Beverly Hills Surgical Center.
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