Third-party implant billing company Access Mediquip is accusing UnitedHealthcare Insurance of failing to pay for surgical devices used on patients covered by health plans the insurer administered.

According to a lawsuit filed against the insurance company, Access alleges that it has thousands of claims for pain pump and non-pain pump medical devices that have not been fully paid for by United. In each case, Access provided the devices for surgical procedures performed on patients covered by health plans administered by United and governed by the Employee Retirement Income Security Act (ERISA).

In 3 exemplar cases brought before the U.S. District Court for the Southern District of Texas, Access Mediquip claimed that it had contacted United and was assured that the patient was covered for the procedure in question and that Access could bill United for the device. However, United allegedly refused to pay for any or all of the device costs.

In one case, United requested additional information regarding the bill for a lumbar prosthesis, but Access failed to provide the information and United refused to pay, court documents show. In another case, United refused to pay the full amount for a spinal cord stimulator, stating that certain charges were not reimbursable for "this provider in this place of service," according to court documents.

United filed a motion for partial summary judgment, arguing that the state law courses of action filed by Access are preempted by the federal ERISA. In reviewing the 2 sides' arguments, District Judge Nancy Atlas found "no allegation that United representatives told Access that it would pay 100% of all bills submitted for payment regardless of the terms of the applicable ERISA plan."

"Instead, Access challenges United's handling and disposition of Access' request for payment for claims covered by an ERISA plan and, therefore, the state law causes of action are preempted," writes Judge Atlas, granting United's motion for partial summary judgment on preemption.

The judge's Oct. 4 order is just one piece of the larger legal dispute between Access Mediquip and UnitedHealthcare, says George Gibson, a Houston, Texas-based attorney representing Access. Mr. Gibson says the implant billing company is reviewing Judge Atlas' order and is still in litigation with UnitedHealthcare over the thousands of other unpaid claims at issue.

Irene Tsikitas

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