The physicians 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, according to the report.
A New York federal judge, however, determined UnitedHealth conducted an appropriate review of its health plan terms and reasonably determined it was not required to pay the additional fees, according to the report. 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.”
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