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UnitedHealth Loses Appeal Over Cross-Plan Offsetting

Jan. 15, 2019, 5:38 PM

UnitedHealth Group Inc.‘s way of collecting overpayments from out-of-network medical providers isn’t authorized by the insurer’s plans and may violate federal benefits law, the U.S. Court of Appeals for the Eighth Circuit held.

Nothing in the insurers’ health plans “even comes close” to authorizing a practice called cross-plan offsetting, the Eighth Circuit said Jan. 15. The court suggested—without explicitly holding—that the practice violates the Employee Retirement Income Security Act: “at the very least it approaches the line of what is permissible,” the court said.

The ruling could have implications across the insurance industry, where several insurers—including Aetna and a ...