After more than a decade of legal turmoil, physicians in four states have won a concession from the nation's largest insurer to make getting paid less of a hassle, if not to get paid more.
Going to back to 2000, a number of medical societies sued United Healthcare, accusing the giant insurer of improperly denying payments and making it difficult to connect. Among them were the Connecticut Medical Society, Medical Society of the State of New York, the Tennessee Medical Association and the North Carolina Medical Society.
In North Carolina, United Healthcare is the state's second largest insurer with a 20 percent market share and in 2004 it was accused of "systematically deny payment to NCMS members for medically necessary claims to achieve internal financial targets without regard for individual patient medical needs."
Now, United is settling up and paying out $11.5 million, with most of it ($9 million) devoted to upgrading its provider-self service website.
The objective is to reduce delays in claims management and claims resolution, according to the North Carolina Medical Society, which along with the other medical societies will use the rest of the settlement for physician education.
"It is gratifying to have reached a settlement after so many years," said NCMS CEO Robert Seligson. "We look forward to putting this chapter with United Healthcare behind us and to improved business practices between the company and North Carolina physicians."
It was "hard-fought litigation," said Edith Kallas, who served as legal counsel for the medical societies. The settlement offers "significant relief in the areas of claims management and claims resolution." United Healthcare has not commented on the settlement.