Ballad Health has filed a federal lawsuit in Greeneville, Tennessee, against UnitedHealth Group, one of the nation’s largest health insurers.
Ballad alleges that UnitedHealth has systematically denied, delayed or underpaid for care that physicians determined to be medically necessary, while also overstating to the federal government how sick its members are to collect higher taxpayer-funded payments through the Medicare Advantage program. Through the suit, Ballad Health aims to protect patients, physicians and hospitals across the Appalachian Highlands.
The legal action marks the first time Ballad Health has sued an insurance company, and leaders said the decision was made only after years of attempting to resolve payment and patient care issues without success.
Ballad Health serves a largely rural region, where more than 75% of patients rely on government programs such as Medicare or Medicaid or have no insurance at all. Roughly 55% of Ballad Health’s patients are covered by Medicare, and nearly three-quarters of those are enrolled in Medicare Advantage plans, most with UnitedHealth.
Ballad Health said UnitedHealth’s denials of post-acute care for seniors can leave patients hospitalized longer than needed, increasing the risk of hospital-acquired conditions, contributing to longer wait times for emergency and inpatient services and, ultimately, costing patients and hospitals more money.
The complaint also cites national reports alleging that UnitedHealth subsidiaries have acquired physician practices and used aggressive coding tactics to increase payments from Medicare, while simultaneously pressuring providers to see more patients and reduce spending on care.
Ballad Health said it will not renew its Medicare Advantage contract with UnitedHealth when it expires on June 30, 2027. The decision applies only to that contract; Ballad Health will continue to work with UnitedHealth on its commercial, Medicaid and exchange insurance plans when those contracts come up for renewal.
