December 22, 2021
UnitedHealth Group and CVS Health’s Aetna have been hit with a trio of lawsuits alleging the insurance companies failed to properly reimburse surgeons.
Physicians at the Surgical of Greater New York and New York-based Seckin Medical filed three lawsuits charging insurers with underpaying for services performed at Northwell Health’s Lenox Hill Hospital in the city.
The three surgeons named in the lawsuits, Dr. Tamer Seckin, Dr. Karli Goldstein and Dr. Panagiotis Manolas, performed operations on patients in 2019 and 2020 they deemed medically necessary and were paid a small fraction of what they are owed, the complaints allege.
Following the surgeries, the patients’ insurers received claims upwards of $200,000 but the payers initially only reimbursed the surgeons a couple thousand dollars.
Aetna and UnitedHealth Group denied payment for certain procedure codes the insurers categorized as inclusive of other codes, according to the lawsuits. The insurance companies also didn’t account for the severity and complications related in the procedures, the doctors claim.
Despite appeals, the insurers haven’t paid the remaining balance and are wrongfully withholding money, according to the lawsuits. Seckin and Goldstein are seeking $277,956.37 and $218,515.92 in two lawsuits and Manolas is suing for $280,381.98 in a third.
Additionally, the Surgical Specialists of Greater New York is requesting an administrative penalty of $19,470, because UnitedHealth Group subsidiary UMR hasn’t provided the plaintiff’s lawyers with documents they requested in June, in violation of federal law, the lawsuit says.