A major insurer in the state has agreed to spend $11.5 million to settle a lawsuit brought against it by physicians organizations, including the Connecticut State Medical Society.
The original suit was filed in 2001, and claimed that UnitedHealthcare used unfair and deceptive practices that were "designed to delay, deny, impede and reduce lawful reimbursement" to doctors. The resolution involves four state medical societies - including ones from Connecticut, New York, North Carolina and Tennessee.
Matthew Katz is the CEO of the Connecticut State Medical Society. Here's how he described one part of the original problem:
"You went to the doctor, had three services done by that doctor, and United only approved or paid for one of those three," Katz said. "You didn't know why or which ones they approved and so, therefore, you, as the patient, were stuck paying the difference. Or the doctor never got paid for the difference between what United paid for and what the doctor billed."
Katz said UnitedHealthcare will spend a minimum of $9 million internally to fix its own systems when it comes to claims management, and resolution as it relates to doctors. The settlement also calls for the insurer to give money to the Connecticut State Medical Society Physicians Health and Education Fund for programming.
In a statement, UnitedHealthcare said it was pleased to resolve the case, and looked forward to new ways of working with the state's medical society.
