Device Supplier Sues Insurer for Claims Payment

The U.S. District Court for the Southern District of Texas ruled Oct. 4 on a lawsuit filed last year by Access Mediquip. The third-party implant billing company is suing UnitedHealth Group for nonpayment of medical devices used in surgical procedures performed on patients who were enrolled in plans governed by the Employee Retirement Income Security Act (ERISA).

Access alleges that it contacted United before accepting each referral to purchase a device and was told by the insurer each time that the patient and device were covered, but then failed to pay the claim. According to the lawsuit, Access filed thousands of claims for pain pump and non-pain pump devices for which they were not properly reimbursed. Although there are thousands of claims at issue, the court required discovery on just the largest 300 non-pain pump claims.
United contends that state law causes of action filed by Access are preempted by ERISA, and the insurer requested a summary judgment.
District Judge Nancy Atlas found “no allegation that United representatives told Access that it would pay 100% of all bills submitted for payment regardless of the terms of the applicable ERISA plan.”
“Instead, Access challenges United’s handling and disposition of Access’ request for payment for claims covered by an ERISA plan and, therefore, the state law causes of action are preempted,” writes Judge Atlas, who granted United’s motion for partial summary judgment on preemption.

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