  |
|
        |
|
    |
Examples of Current CasesUsual, Customary & Reasonable ManagedCare Reimbursement Formula Cases Lead Cuneo Gilbert & LaDuca, L.L.P. Attorneys: This suit, pending in the U.S. District Court for the Southern District of New York, is brought under the Employee Retirement Insurance Security Act ("ERISA") by, among others, a putative class of individual medical insurance insureds, against one of the largest health insurance companies in the country. The suit alleges that United Healthcare promises its insureds that it will reimburse them a fixed percentage - usually 80% - of their medical bills using a formula based upon the "usual, customary and reasonable" ("UCR") charges for such services in the area where the services are provided. Instead, the suit alleges, United Healthcare has a frequent practice of reducing the amount it reimburses, using flawed or inadequate UCR data, resulting in its insureds ending up paying more than the correct co-pay amount they agreed to pay in their insurance contracts. The case is currently in the discovery stage. |
     |
  |