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A class-action lawsuit accuses UnitedHealthcare Group of systematically underpaying benefits for care received from out-of-network health care providers. This practice violates the terms of their plans and breaches United's fiduciary obligations under ERISA, according to complaint.
Many self-funded health plans administered by United, including those of the plaintiffs, state that United will base reimbursement amounts for covered out-of-network services on "competitive fees" in a provider's geographic area. But according to the complaint, United often ignores this promise and instead uses deeply discounted "repricer" rates that make just a fraction of a billed charge eligible for reimbursement. Out-of-network providers are not required to accept this rate, which means plan members are legally obligated to pay the difference.
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