UnitedHealth hits back at Envision over ER billing practices


By Shelby Livingston

March 20, 2018

UnitedHealth Group has shot back at physician staffing firm Envision Healthcare over allegations surrounding emergency room billing, creating a website blaming Envision for patients’ costly emergency room bills.

The two companies are locked in a dispute over payment issues. Envision, which has previously landed in hot water with lawmakers and researchers over surprise out-of-network billing practices, sued UnitedHealth on March 12, claiming the insurer violated a contract by refusing to add Envision doctors to its network and lowering payment rates despite Envision’s objections.

Envision also said UnitedHealth is trying to collect more than $140 million in overpayments to the staffing firm based on the newly lowered rates.

UnitedHealth Group shot back with a website describing how Envision’s “outrageous billing practices” drive up costs for hospitals and patients. The website’s launch was first reported by Axios.

In a fact sheet about Envision, UnitedHealth said it is negotiating a new contract with the staffing firm to protect patients from high costs and surprise medical bills. The insurer claimed Envision charges an average of 975% of what Medicare pays for the same services—more than the average cost of an out-of-network ER bill at 798% of the cost of what Medicare pays, according to the Brookings Institution.

Nashville-based Envision is the nation’s largest physician staffing firm with 25,000 physicians and other medical practitioners who staff hospital departments, including the emergency room, radiology, anesthesiology and neonatology. Envision’s 2017 revenue totaled more than $7.8 billion.

Envision last year was scrutinized for sending patients big out-of-network ER bills. A July 2017 Yale University study found that hospitals that outsourced their emergency department operations to Envision unit EmCare experienced increases in the rates of out-of-network doctor’s bills, tests ordered and patients admitted to the ER. In September, Sen. Claire McCaskill (D-Mo.) wrote a letter to Envision CEO Christopher Holden requesting information on Envision’s billing practices in light of the study.

In its lawsuit against UnitedHealth, Envision puts the blame for big patient bills on the insurance company. UnitedHealth refused to add new Envision doctors to its network after Envision merged with ambulatory surgery center operator AmSurg in 2016, the lawsuit alleged.

“The impact of United’s conduct extends beyond plaintiffs to patients who are United enrollees,” the complaint said. “United’s unjustified refusal to affiliate entities timely or at all hurts patients financially, while saving United money at the patients’ expense.”

Envision also alleged that UnitedHealth lowered contracted rates in violation of a provider agreement and has pressured Envision doctors to contract with the insurer on “unreasonable terms” or stay out of network.

“We are currently negotiating a new contract with Envision to end their outrageous billing practices, which drive up costs unnecessarily for both consumers and hospitals. The lawsuit won’t distract us from the negotiation and the real conversation that is needed about their excessively high rates,” a UnitedHealth spokesman said in a statement.

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