NYC Health + Hospitals Seeks $11.5 Million from United Healthcare for Wrongful Denials
Public Health System's Pursuit of Arbitration Reflects Its New Approach to Seek Fair Reimbursement for Services Provided
May 22, 2018
NYC Health + Hospitals is pursuing arbitration to recover $11.5 million in wrongfully denied bills submitted to United Healthcare, the public health system announced today. Covering July 1, 2014, to December 31, 2017, the bills reflect care provided to United Healthcare beneficiaries in the inpatient settings of NYC Health + Hospitals.
“For too long, NYC Health + Hospitals has been leaving money on the table and subsidizing private insurance companies by letting denials slide,” said Mitchell Katz, MD, president and CEO of NYC Health + Hospitals. “Our clinicians provide high-quality care and advance our mission every day. It’s our responsibility to stand up for them and challenge wrongful denials, as all health systems should.”
“Our pursuit of arbitration is just one component of our new approach to working with our managed care partners,” said Matthew Siegler, senior vice president for managed care and patient growth at NYC Health + Hospitals. “We expect to have very productive relationships with health plans as we work together to improve access and patient experience across our system. Negotiating fair rates and terms with private insurance companies and collecting accurate payment for services rendered are critical elements of those relationships.”
The NYC Law Department, which represents the City and its affiliated agencies in legal matters, will be responsible for arbitrating the dispute, which will take place in Manhattan later this summer.
NYC Health + Hospitals is reviewing all of its current managed care contracts and denials as it modernizes its financial operations. The system may pursue arbitration against other health insurers or take similar actions to appropriately collect revenue it is due.