2nd ASC in 1 week sues UnitedHealthcare for alleged underpayment

Surgery Center of Viera in Melbourne, Fla., on May 2 filed a lawsuit against UnitedHealthcare for alleged repricing and underpayment of a spine surgery performed in 2019.

Six notes:

1. The ASC, which includes neurosurgeon Ara Deukmedjian, MD, and interventional pain management specialist Bharat Patel, MD, operated on a patient who was insured through the Brookdale Senior Living Welfare Plan, which is administered by UnitedHealthcare, according to court documents.

2. The surgery center received authorization to perform the services on the patient but was paid only $16,125.56 on a final bill of $193,438, according to the complaint. The providers allege UnitedHealthcare never explained the disparity between the billed charges and the payment.

3. The complaint alleges the bill was sent to third-party repricing company, Viant, but the insurer did not provide documents permitting such repricing under the patient's plan.

4. Attorneys for Surgery Center of Viera argue the payment amount should have been 80 percent of the billed charges per the contract at the time of services and that the alleged underpayment represents a breach of contract.

5. On April 28, Fort Lee, N.J.-based Advanced Surgery Center also filed a lawsuit against UnitedHealthcare for allegedly failing to pay for hernia-related procedures.

6. Becker's has contacted UnitedHealthcare to provide a comment on the lawsuits.

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