UnitedHealth is facing a proposed class-action lawsuit alleging the insurer underpaid for telehealth services.
The lawsuit was filed July 7 by a Chicago woman who receives a UnitedHealth insurance plan through her employer. Her plan provides coverage for telehealth services, and the written terms state that UnitedHealth will pay benefits for services from out-of-network providers equal to 110 percent of the amount that Medicare would pay for the same services, according to the lawsuit.
The woman received in-person psychotherapy services from an out-of-network provider prior to the pandemic. She switched to telehealth services from the same provider in July 2020, according to the lawsuit. In March 2020, CMS changed rates of telehealth services to match those of in-person services. UnitedHealth allegedly continued to reimburse at the old, lower rate. The payer allegedly denied appeals by the woman to reprocess her claims.
The lawsuit alleges that by refusing to adhere to CMS policy, UnitedHealth was able to "take advantage of the increased use of telehealth services resulting from the COVID-19 pandemic to pay less in benefits for the same covered services, thereby enriching itself at the expense" of those it insures."
UnitedHealth is accused of violating its fiduciary duties under the Employee Retirement Income Security Act by deliberately calculating and paying for benefits at a lower rate than the woman's plan prescribed.