Court sides with UnitedHealthcare but Envision claims the win in contract dispute over billing

A judge has dismissed a lawsuit brought by Envision Health against UnitedHealthcare in a long-standing dispute over emergency room payment rates.

Envision Healthcare and Sheridan HealthCorp sued UnitedHealthcare saying the insurer changed their payment rate agreement.

[Also: Envision sues UnitedHealthcare over contract dispute]

UnitedHealth said Envision, which staffs emergency room physicians, charged patients at rates three times higher than what it should have levied. Envision said this was due to out-of-network charges because the insurer refused to bring Envision provider groups into their contract agreement.

The contract calls for disputes to go to binding arbitration, but in the lawsuit, Envision claimed that by changing the payment rate, United waived the arbitration provision. United said it had not waived its arbitration right.

On April 26, the U.S. District Court in Southern Florida sided with UnitedHealthcare. 

Envision said some reports have characterized the decision as a win for United but it's a win for them because the insurer will be held to the arbitration guidelines in a contract that to date they have refused to acknowledge. 

"Envision is appreciative for this decision that allows us to enforce our rights against United's unlawful practices," the company said by statement. "Whether in court or in arbitration, caregivers and patients need a voice against unfair insurance practices that leave patients without adequate insurance coverage."

UnitedHealthcare said it had no comment at this time beyond what was said in the court ruling. 

On a factsheet on its website, UnitedHealthcare blamed Envision Healthcare and other companies that manage emergency rooms, saying some private contractors operating ERs charge significantly more and balance-bill patients for sometimes hundreds of thousands of dollars.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com