Raja Sékaran Comments on Billing Fight Between UnitedHealthcare and TeamHealth

AIS Health Plan Weekly

Raja Sékaran was quoted extensively in the AIS Health Plan Weekly article “TeamHealth Wins One Battle in Ongoing War With UnitedHealth.

The article examines a recent verdict that found UnitedHealthcare underpaid Nevada emergency care sub­sidiaries of TeamHealth Inc. in out-of-network billing scenarios. This is the first of several suits between the two entities to have been decided – UnitedHealthcare and TeamHealth have 10 matters in litigation across a number of states. 

The matters stem from disputes over billing rates going back to 2019. Blackstone Inc. acquired TeamHealth in 2017 and started to raise rates in 2018. The Nevada suit resulted in a jury award for TeamHealth of $2.65 million in damages, and the Nevada court may award the provider group additional punitive damages.

Commenting on the matter, Raja said, “It’s safe to assume they [UnitedHealthcare] have some appellate at­torneys poring over the transcript now, trying to find errors.”

One of the issues at play in the lawsuits is out-of-network emergency services charges – which many times result in providers billing patients directly for those charges not covered by their insurance as an out-of-network benefit. This practice will become illegal when the No Surprises Act comes into effect in January. Commenting on how this will impact the legal fight between UnitedHealthcare and TeamHealth, Raja said, “I don’t know that the No Surprises Act solves the rate-setting question for out-of-network emergency care… it’s not uncom­mon for emergency treatment to take place at an out-of-network facility.”

He added, “An emergency patient, by defini­tion, cannot get authorization for care before the care is provided. Under EMTALA [the 1986 Emergency Medical Treatment and Active Labor Act], emergency care providers are not supposed to check insurance status before providing the care necessary to screen and stabilize the patient. So unless the health plan has a really robust network that has every potential provider under contract, it’s going to raise that issue.”

Raja closed by saying, “Some states have solved this prob­lem through legislation… California passed a law that allows the state to set rates for out-of-network care. But even with that law, I don’t know that I could say that it’s complete­ly solved.”

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