Out-of-Network Provider ERISA Rights – UHC Recoupment Demands

September 29, 2021

Nashville, TN — A recently settled class-action lawsuit gives out-of-network (OON) physicians/allied health care professionals (providers) appeal rights for ERISA claims subject to recoupment demands by UnitedHealthcare (UHC). Prior to this settlement, a recoupment demand sent to an OON provider did not include any information regarding appeal rights.

Members of the class include any OON provider that received a recoupment demand from UHC after Jan. 24, 2005 and has not been resolved through reimbursement by UHC or recoupment by June 2, 2021.

For recoupment demands issued in the 12 months prior to June 2, 2021, UHC is required to provide a spreadsheet to each class member containing information about each demand.

For recoupment demands after June 2, 2021, UHC is required to treat OON providers as a patient’s authorized representative under ERISA for purposes of a recoupment when the provider submits a completed Designation of Authorized Representative form. Click here to access this form.

If you do not receive a spreadsheet regarding outstanding recoupments by Dec. 31, 2021 or UHC does not accept the authorized representative designation form you submit, contact Karen Baird at karen.baird@tnmed.org or 615-460-1651.

If you need help appealing an adverse determination by an ERISA plan, TMA has resources available at tnmed.org/ERISA (member login required).