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Envision sues UnitedHealthcare over contract dispute

The insurer claims ER physician staffing firm is charging 'outrageous' rates, while Envision blames UnitedHealthcare for out-of-network charges.

Susan Morse, Managing Editor

UnitedHealthcare is calling out Envision Healthcare for what the insurer calls its "outrageous billing practices" leading to increased costs for hospitals and consumers.

Envision Healthcare has fired back in a lawsuit against UnitedHealthcare brought on March 12 in U.S. District Court in the Southern District of Florida.

[Also: UnitedHealth Group reports 18% earnings increase]

Envision Healthcare, through its EmCare division, staffs emergency room department physicians.

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UnitedHealthcare is accusing Envision of charging patients emergency room rates that are three times higher than what they would normally be charged, but Envision claims this stems from out-of-network charges because the insurer refuses to bring new Envision provider groups into their 2009 contract agreement.

This is part of an overall strategy to pressure Envision to contract with UnitedHealthcare on unreasonable terms or to be out-of-network, according to the lawsuit.

UnitedHealthcare said it wants to adjust the contractual rates downward, and has taken steps to negotiate a new agreement with Envision, according to information on a UnitedHealthcare website first reported by Axios. 

"Envision Healthcare charges on average 975 percent of what Medicare pays for the same services, driving up costs for both hospitals and consumers," UnitedHealthcare said.

UnitedHealthcare agreed patients in the ER are being treated by out-of-network physicians at in-network facilities, causing out-of-network bills for one in three adults.

Many issues are contributing to a dramatic rise in the cost of emergency room visits, the website said.

"But one of the more prominent is the growing number of private contractors now operating the ER at your local hospital," UnitedHealthcare said. "Because they are not employees of the hospital, they use it as an opportunity to charge significantly more for your care and in some cases balance bill you for hundreds or thousands of dollars."

The lawsuit was the next step after multiple attempts to resolve the contractual situation, Envision said by statement Wednesday.

"United Healthcare is in breach of contract by failing to recognize Envision medical providers, unfairly adjusting rates it pays Envision and refusing to comply with the contract's process for handling disputes. We are asking the courts to hold United accountable for its contractual agreements and obligations. Envision believes that UnitedHealthcare is choosing to place dedicated physicians and patients in the middle of a contractual dispute to further its competitive business strategies."

Twitter: @SusanJMorse

Email the writer: susan.morse@himssmedia.com