United Insured Claims Sentara RMH Medical Center Overbilled for Services at Outpatient Facilities

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A proposed class action alleges Sentara RMH Medical Center and United Healthcare have systematically overcharged certain patients for services rendered at Sentara’s outpatient centers by billing for them as though they were performed at the company’s main hospital. 

According to the 18-page lawsuit, defendant United Healthcare Insurance Company’s contract with RMH Medical Group, the entity who provides services at Sentara’s outpatient facilities, has lower negotiated rates for medical services than the insurer’s contract with Sentara RMH Medical Center, the Harrisonburg, Virginia hospital. 

The plaintiff, who receives his health insurance through his employer, Rosetta Stone, alleges that Sentara bills for services performed at RMH Medical outpatient centers under the higher agreed-upon rates for services performed at the hospital. United, for its part, then processes those services under the higher rates, causing people to be overcharged, the suit says. Per the case, when the plaintiff had bloodwork done in the summer of 2019 at Sentara’s East Market Street Health outpatient location, Sentara falsely told United that the service had been performed at its main hospital location. 

“Despite being repeatedly put on notice of this practice, United Healthcare Insurance Company does not correct the bills,” the suit claims, alleging United “knew or should have known that Sentara was improperly billing these services” yet failed to take steps to ensure patients would receive the benefits due to them under their health insurance plans. 

Sentara billed the plaintiff more than $152 for the bloodwork, “far greater” than the rate at which it would have been billed had the service been reported as provided at a Sentara outpatient facility, the lawsuit relays. 

The plaintiff claims that before paying the charge to keep it from going to collections, he repeatedly contacted United Healthcare, pointing out that its website stated the estimated charge for medical services at that outpatient location should have been much lower. 

“[The plaintiff] repeatedly asked United Healthcare to provide the details about how Sentara billed the services because he reasonably thought some mistake had occurred in how Sentara had billed it,” the suit says. “United Healthcare repeatedly responded that it had processed his claim properly.” 

When the plaintiff asked Sentara to provide “specific details” about how it billed for the provided services, he received no response, according to the complaint. 

The plaintiff also claims to have been overcharged for bloodwork done in June 2021 at another Sentara outpatient facility, as though the service had been performed at the main Sentara RMH Medical Center, the lawsuit adds. Again, the plaintiff contacted United and informed the insurer that its website provided an estimated charge for services at that outpatient facility that had been much lower than the more than $221 he was billed, the suit says. Per the complaint, these efforts again led to repeated phone calls and written appeals to United, who asserted that it had processed the man’s claim correctly. 

According to the lawsuit, the plaintiff learned of the billing rates for outpatient facilities versus Sentara’s main hospital after filing a General District Court action against United Healthcare for “displaying vastly lower amounts for these medical services at the East Market Health Center than he would actually be charged.” In the case, United ultimately declared that it had “two contracts” with Sentara, one for the outpatient Sentara RMH East Market Health Center, and one for the main hospital, the filing says. 

The lawsuit looks to cover all people insured through an employer-provided health insurance plan from a United Healthcare entity who received medical services at an outpatient center affiliated with RMH Medical Group, LLC, and where the bill for those services was submitted to United Healthcare as though the services were performed by Sentara RMH Medical Center, within the last four years. 

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