Here are five things to know:
1. The complaint alleges United and OptumInsight improperly calculated the reasonable and customary amounts for out-of-network ASCs, leading to millions of dollars in underpayments.
2. United agreed to a $9.5 million settlement fund.
3. There are an estimated 250 ASCs that could qualify to participate in the settlement, if the court preliminarily approves the settlement. Steps to participate in the settlement will be sent to all potential class members.
4. The class representatives came from Downey Surgical Clinic and Tarzana Surgery Center.
5. The case challenged payment calculations of reasonable and customary amounts under employer-provided healthcare benefit plans and health insurance policies governed by the Employee Retirement Income Security Act.
“After a long battle, we believe that we have reached a fair settlement that will adequately compensate the class of surgery centers whose claims were underpaid,” said HLB Attorney Daron Tooch, a lead attorney representing the ASCs.
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At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.