Appeals court upholds UnitedHealth win in facility fee case

A federal appeals court upheld UnitedHealth Group's win in a class-action lawsuit by more than 200 physicians who said they were not paid facility fees for office-based surgeries. 

The lawsuit brought by the Medical Society of the State of New York alleged that UnitedHealth violated the Employee Retirement Income Security Act and breached terms of health plans by failing to pay facility fees out-of-network surgeons charged for office-based surgeries.

A New York federal judge in September determined UnitedHealth conducted an appropriate review of its health plan terms and reasonably determined it was not required to pay the additional fees. The judge said none of the health plan documents had language "plainly requiring" the insurer to pay those fees, adding that many "clearly precluded such payments."

The U.S. Court of Appeals for the Second Circuit affirmed the lower court's decision Jan. 17, according to court documents. 

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