UnitedHealth Group is probably one of the biggest health insurance companies out there in the United States, and when you see them get into some kind a legal issue, it raises all the red flags for you, right? Well, if you don’t know what is going on right now well then just know that recently, the U.S. Department of Labor, short for DOL, sued UnitedHealth. But why? You see, as per DOL’s claim or allegations which we found out in the case details, UnitedHealth’s specific division called the UMR actually unfairly denied thousands of health insurance claims in the country. Yes, “unfairly” that is. Though, this lawsuit was first brought up back in 2023, and it was actually recently when we saw that UnitedHealth Settles DOL Lawsuit. So, let’s see the details of it all and see what really went down.
Why Was UnitedHealth in Trouble? Aka The Allegations
See, when the government dug into the complaints against UnitedHealth by thousands of customers, they found out two major things which are also mentioned in this lawsuit’s details. Here:
Well, the first issue and major thing was the way UMR actually handled the energy room (ER) claims. What they were found doing is that they just relied only on the financial diagnosis codes, and not the actual situation of the patient. The government went on with an allegation that the UMR division actually straight up didn’t follow the “prudent layperson” rule and wrongly denied the ER claims of so many patients out there.
And talking about the 2nd major thing or issue, well, that had something to do with urinary drug screenings (UDS). As per the details that are already out, the UMR division was automatically denying all the UDS claims without even checking on the details like if they were medically necessary.
So yes, all in all, these are pretty severe allegations, and these aren’t the things you expect from a big insurance company like UnitedHealth.
So, How Many People Were Affected?
As per the actual number, UMR ended up denying health claims for at least 2,136 people so far, which is the minimum number. And yes, it was all done wrongly, though the company itself has denied doing any wrongdoing yet.
Just to give you perspective on things, all of this claim denial thing was going on ever since January 2015, and it kept on until this very lawsuit was filed back in 2023.
The Settlement Details
The lawsuit is settled now? Oh yes, it is! UnitedHealth agrees to settle this lawsuit by paying about $20.25 million to avoid a long court battle. And sure enough, most of this money will be used to compensate patients and healthcare providers who were affected by this entire claim denial drama that was going on for nearly 8 years.
That’s not it though, the UMR division has also agreed to reprocess all the claims that they denied previously, which means the patients or people who had their claims denied automatically, now have the chance to get the compensation. For example, patients can expect to receive between $68.85 and $103.27 per urinary drug screening claim, and up to $353.22 per ER claim.