The award dates to 2017 and 2018, when Envision and UnitedHealthcare had an in-network agreement.
An independent arbitration panel has ruled that for-profit physician services provider Envision Healthcare is owed $91.2 million in its long-running fight with UnitedHealthcare over disputed payments.
UnitedHealthcare could pay even more, because the three-member panel from the American Arbitration Association may also consider additional payments to cover prejudgment interest and Nashville-based Envision's attorney's fees, court costs, and other expenses related to the dispute, which dates back to 2017.
Jim Rechtin, CEO of private equity owned Envision, says the physician services provider is "very pleased with the outcome," but complained that "it should not take five years to get paid for the lifesaving care our clinicians provide."
"We currently have three other lawsuits against UnitedHealthcare, which will likely take several more years to resolve. It is challenging to create a stable environment for our teams when health plans choose not to pay their bills," Rechtin says.
The award dates to 2017 and 2018, when Envision and UnitedHealthcare had an in-network agreement. Envision complained that UnitedHealthcare breached the terms of that contract when it unilaterally cut payments for services Envision rendered as an in-network provider.
In a statement emailed to HealthLeaders, UnitedHealthcare noted that the settlement is unrelated to its other lawsuits with Envision.
A spokesman with the Minnesota-based payer says they "disagree with the panel's decision."
"However, it did reject many of Envision's claims, including damages it was seeking," the spokesman says. "We remain committed to helping contain rapidly rising healthcare costs for the people and employer customers we're privileged to serve. We'll continue efforts to protect our members and customers from the small number of bad actors—often private equity-backed physician staffing companies like Envision—who demand unreasonable and anticompetitive rates for their services and drive up the cost of care for everyone."
Rechtin says the decision "sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need."
"While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel's decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide," he says.
“This decision sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need.”
Jim Rechtin, CEO, Envision Healthcare
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
Envision CEO Jim Rechtin says the for-profit physician services provider is 'very pleased with the outcome' but complained that 'it should not take five years to get paid for the lifesaving care our clinicians provide.'
A spokesman for UnitedHealthcare says they 'disagree with the panel's decision. However, it did reject many of Envision's claims, including damages it was seeking,'