Mayo Clinic, Medica Sued Over Out-of-Network Provider Pay (1)

A Mayo Clinic employee filed a proposed class action saying the clinic’s employee health plan and its claims administrator systematically underpaid for services performed by out-of-network doctors.

Defendant Medica Health Plan Solutions uses deceptive and unpredictable methods for determining how much to reimburse out-of-network providers that treat participants in the Mayo Clinic health plan, the employee said in a complaint filed Tuesday in the US District Court for the District of Minnesota. These methods cause providers to be dramatically underpaid, leading them to send “enormous balance bills” to plan participants that must be paid out-of-pocket, according to the complaint.

The ...