UnitedHealthcare in dispute with maternity practice over $1M in claims

UnitedHealthcare is accused of disrupting coverage for patients at a large OB-GYN practice in New Jersey following a dispute over reimbursement rates, despite agreeing not to do so.

According to doctors at Axia Women’s Health, the practice and the insurer parted ways last April when they were unable to reach an agreement on the cost of care. However, UnitedHealthcare agreed not to pull coverage for patients who were currently undergoing cancer treatment or who were in the middle of their pregnancies.

Despite the continuity of care agreement with both the practice and its members, Axia said medical claims totaling roughly $1 million were denied by UnitedHealthcare for being “out of network.” In total, the practice reported 2,300 patients were forced to file appeals, which have so far gone unanswered.

According to a report from NJ.com, UnitedHealthcare is blaming Axia, claiming the practice was billing for care at rates 30% higher than the market rate. The practice disagrees, adding that the insurer pays hospitals more for the same care, sometimes at rates 20% higher than what Axia is seeking.

The report estimates 60,000 people—mostly women and maternity patients—have been left without coverage due to the dispute. Many have reported being forced to delay care or miss appointments, while others have lamented unpaid bills. Some patients who spoke to NJ.com also claimed doctors at Axia were pushing unnecessary treatments, seemingly to boost revenue.

Despite federal laws mandating that insurers honor continuity of care agreements, it remains unclear when this conflict will be resolved, given the facts have yet to be established and no lawsuit has been filed. 

For more details, read the full report from NJ.com at the link below.