NYC Health + Hospitals seeks $40.1M from UnitedHealthcare for alleged wrongful claim denials

New York City-based NYC Health + Hospitals is accusing UnitedHealthcare of wrongfully denying $40.1 million in bills submitted by the public health system.

The $40.1 million — which the system seeks to recover through arbitration — marks an increase from the original amount alleged by NYC Health + Hospitals. In May, the system accused UnitedHealthcare of wrongfully denying $11.5 million in bills and announced its intent to recover the amount from the insurer.

NYC Health + Hospitals said it continues to seek reimbursement for inpatient care provided between July 1, 2014, to Dec. 31, 2017.

It said the larger $40.1 million total reflects more alleged reimbursement denials that were not included in an initial review. One newly added case is a 1-year-old girl hospitalized with an elevated heart rate and a fever related to an abscess, according to the system. The girl required surgery consultation for incision and drainage, as well as IV antibiotics.

Other alleged denied claims came from a 25-year-old pregnant woman with a history of miscarriages and a 32-year-old man who was transferred from a psychiatric unit for flu treatment.

Arbitration is expected to begin on the initial cases and newly added cases this fall. The New York City Law Department will represent the system in arbitration.

"I have read through many of the nearly 4,000 wrongful denials and am appalled to think that UnitedHealthcare truly believes that this baby, or this pregnant woman, or this man with behavioral health challenges did not need the care that we provided," said Matthew Siegler, senior vice president for managed care and patient growth at NYC Health + Hospitals.

UnitedHealthcare told Becker's: "We have offered to meet with NYC Health + Hospitals to review their concerns, but they have declined our invitation. We remain willing to meet with them as soon as they are ready to address this issue with us directly."



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