Charlotte-area patients sue United HealthCare over high bills

What’s happening: The class-action suit filed in Mecklenburg County Superior Court last week is the result of a dispute between UHC and Providence Anesthesiology Associates, which left people with UHC insurance out of network with PAA’s services.

Why it matters: That’s a big issue because Novant Health, one of our areas’s largest health systems, exclusively works with PAA for anesthesiology services. So any UHC patient needing anesthesia at a Novant facility between February 2020 and now has gotten an out-of-network bill.

• Many of those patients are new mothers who received an epidural during childbirth.
• Of note: Many of these bills were lowered after individual negotiations with UHC and or help from PAA.

Zoom out: We’ve been reporting on this dispute since September 2020. Some patients say they didn’t know about PAA’s out-of-network status before reading our stories. And some mothers have told us the dispute has caused them to skip the epidural altogether.

[Go deeper: Healthcare provider feud leads to thousands in unexpected anesthesiology fees for new Charlotte parents, Update: They’ve endured miscarriages and breast cancer. Now these Charlotte patients are caught in the middle of a healthcare provider feud, Charlotte moms still face high epidural costs as healthcare dispute continues]

The lawsuit alleges that UHC “violated North Carolina’s Patient Protection Act by forcing members to use out-of-network providers, then refusing reasonable reimbursement.”

• The suit also says that UHC “subjected patients to unnecessary financial hardship and related stress when it moved longtime provider Providence Anesthesiology Associates out of network.”
• Six Charlotte-area patients, along with PAA, are plaintiffs in the lawsuit.

What they’re saying: UHC sent Axios a statement in response to the lawsuit:

“The fact that Providence has joined a lawsuit focused on the surprise bills that Providence itself has been sending to patients is just the latest example of the extreme lengths to which it will go to protect its egregious billing practices. Providence’s out-of-network charges are 15 times higher than Medicare pays on average, and when insurers don’t pay those exorbitant charges and instead offer market-competitive reimbursement, Providence surprise bills patients. Fortunately, the No Surprises Act will make it illegal for Providence to continue this practice starting in 2022. In the meantime, we will vigorously defend ourselves against the claims in this lawsuit and will continue doing everything we can to protect our members from Providence’s surprise bills.”

Pointing fingers: Over the last year and a half, UHC and PAA have placed responsibility for the dispute on the opposing party. UHC has blamed PAA for charging too much for their services, and PAA has blamed UHC for undercutting anesthesiology groups like theirs.

• Multiple attempts to negotiate and get PAA back in network have failed.

The big picture: The lawsuit, the dispute that caused it and the resulting medical bills highlight the complexities of the American healthcare system.

Currently measures like the Hospital Price Transparency rule have been implemented to make the healthcare industry more competitive and transparent. But these changes take time. As of right now, reports show that most hospitals are out of compliance with the rule.

[Go deeper: Charlotte hospitals aren’t complying with the price transparency rule, study finds]

Attorney General Josh Stein’s office says it’s received seven complaints involving PAA, and many other complaints involving UHC, but those are regulated by the Department of Insurance.

Stein says he’s dealt with other cases similar to the PAA/UHC dispute. He see’s price transparency as a big part of the solution.

“The biggest problem is the incredible complexity of our health care financing system. Having transparency of the pricing procedures in health systems is a critical first step,” Stein tells me.

Currently the attorney general says his office is working to determine which hospitals are out of compliance with the price transparency rule.