In October 2015, Texas General sued UnitedHealthcare for “drastically underpaying” the hospital and not paying for care provided to UnitedHealthcare members. In November, UnitedHealthcare motioned to dismiss the lawsuit. Chief Judge Barbara M.G. Lynn of the U.S. District Court for the Northern District of Texas denied UnitedHealthcare’s motion on June 28.
The judge’s dismissal allows Texas General to pursue its claims for benefits and relief under the Employee Retirement Income Security Act. It also allows the hospital to bypass the payer’s internal appeals procedures for all 1,969 patients and head straight to federal court, Bloomberg BNA reported.
Texas General can also pursue state law claims over non-ERISA plans, as well as its accusations UnitedHealthcare violated ERISA by not adequately reviewing the hospital’s claims. However, Ms. Lynn did dismiss Texas General’s claims that UnitedHealthcare breached ERISA’s fiduciary functions.
The case is Texas General Hospital L.P. and Texas General GP L.L.C. v. UnitedHealthcare Services Inc. and UnitedHealthcare Insurance Co.
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