Amica Mutual Medicare Advantage Accident Claims Class Action

This class action against Amica Mutual Insurance Company in its role as a Medicare Advantage insurer. The complaint alleges that Amica has refused to pay accident-related medical expenses, despite their role as primary payers for those enrolled under Medicare Advantage (MA) plans. This leaves Medicare, which was supposed to be the secondary payer, to pay  Read more

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United Health Plans “Cross-Plan Offsetting” ERISA Class Action

Healthcare plans are governed by a law popularly known as ERISA, the Employee Retirement Income Security Act. This class action brings suit against a number of companies in the United Health group for something called “cross-plan offsetting,” in which the companies use the assets of one plan to offset losses in another.  Read more

Stethoscope on Hundred-Dollar Bills

Anthem Blue Cross Refusal to Pay Settlement

Anthem Blue Cross is settling a class action alleging that it refused to pay for treatment for co-morbid diagnoses because it had classified their claims as being for substance abuse only. The co-morbid diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive development disorder or autism, anorexia nervosa, or  Read more

Paying White-Coated Medical Figure

Cigna, Viant Conspiracy to Negotiate Insurance Payments Class Action

Behavioral health problems, such as drug or alcohol addiction, can be difficult and expensive to treat. In this class action, the complaint alleges that Cigna Behavioral Health, Inc. and Viant, Inc. have “systematically undervalued and underpaid” claims, requiring insureds to pay excessive out-of-pocket charges.  Read more

One Person's Hand Lifting Another's with Words "Behavioral Health"

Blue Cross Blue Shield Denial of Proton Beam Radiation Therapy Class Action

Insurance companies have the power to decide what kinds of tests and treatments patients receive. The complaint for this class action claims that Proton Beam Radiation Therapy (PBRT) was delayed or denied for cancer patients by Blue Cross Blue Shield of Florida, Inc. (BCBS), claiming it was not an established treatment.  Read more

Hand and Pen Filling Out Insurance Claim

United Behavioral Health Guidelines and Rejected Claims Class Action

United Behavioral Health (UBH) “administers mental health and substance use disorder benefits for commercial welfare benefit plans,” says the complaint for this class action. But, according to the complaint, UBH’s guidelines for accepting or rejecting treatment under those plans have been flawed and were rejected in a previous class action. This class action seeks to  Read more

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United Healthcare Dropping Providers Without Explanation Class Action

This class action, brought against entities in the UnitedHealthcare group of companies, concerns contracts for a Medicare Advantage (MA) insurance plan. The plaintiffs say they are being dropped as providers without being given any reason and that the process violates MA Regulations and the companies’ provider manual.  Read more

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St. Vincent Seeks Higher Medical Bill Payments Arkansas Class Action

When Nicholas Dorado was injured in an auto accident, he discovered that the facility that treated him did not immediately submit the bills to his insurance company but looked for higher payments than those the insurance company was willing to make. This class action sues St. Vincent Community Health Services, Inc., St. Vincent Infirmary Medical  Read more

St. Vincent Infirmary Building

United Healthcare Takes Part of Accident Settlement to Reimburse Itself Class Action

If you are injured in an accident, and the insurer of the driver who was at fault grants you a settlement, can your health insurance simply take some of that settlement, whether or not you’ve been properly reimbursed for your losses? The complaint for this class action claims that UnitedHealth Group, United Healthcare Services, Inc.,  Read more

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Anthem Blue Cross Payment for Emergency Non-Contracted Providers Class Action

Under California law, insurers must pay reasonable fees to medical providers for emergency services performed on one of their insureds, even if the medical providers are not part of their own networks. California laws also require prompt payment to medical providers. The complaint for this class action claims that Anthem Blue Cross complies with neither  Read more

Sign at Emergency Room