Uncovering Healthcare Profitability

Archive for September 2015

UnitedHealthcare Services Denied Injunction Against Out-of-Network

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by an out-of-network physician. In this case, UnitedHealthcare (“United”) brought an injunction action against an out-of-network (OON) orthopedic physician and his medical […]

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Aetna Improperly Denies or Underpays Out-of-Network Claims

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special Surgery) filed suit in Harris County District Court against Aetna Health Inc. and Aetna Life Insurance Company (Aetna), claiming that Aetna underpaid or […]

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