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Colson Hicks Eidson Secures Multi-Million Dollar Class Action Settlement for Pathologists Against United Healthcare for Medicaid Payments

October 23, 2020
Colson Hicks Eidson

CORAL GABLES, Fla. (Oct. 22, 2020) —Attorney Patrick S. Montoya, partner at the law firm Colson Hicks Eidson, announced preliminary approval of a multi-million dollar class action settlement for Florida-based pathologists against United Healthcare. The class-action settlement secured by Montoya compensates pathologists for 100% of their billing not paid by United since July 1, 2017, plus interest and future payments on United’s Medicaid lines of business. The total benefit to the Florida pathologists for past and future payments will be several million dollars.

Pathologists are medical doctors who examine bodies and body tissues, perform lab tests, and diagnose diseases. “I’m proud to represent pathologists to see that they are properly paid for the valuable work they do on the frontlines of medicine,” said Montoya. “Especially in this time of Covid-19, it is pathologists who designed the testing, process the testing, and produce the results so that we can all live in a safer environment.”

On July 1, 2017, United Healthcare stopped making payments to Florida pathologists for services pathologists rendered to United’s Medicaid members during their emergency room visits or hospital stays. The specific service that United stopped paying for is known as the “professional component of clinical pathology” (PC-CP). PC-CP services include, among other things, the pathologists selecting test methods, overseeing quality assurance and quality control measures, supervising laboratory personnel, reviewing abnormal or unexpected results, and being available to discuss the medical significance of laboratory results with clinicians.

In August 2019, Montoya filed a class-action lawsuit on behalf of Palmetto Pathology Services, P.A., who are the pathologists for Palmetto General Hospital, located in Miami, Florida. Palmetto Pathology Services, via Dr. Michael Abels, served as the lead plaintiff and class representative in the lawsuit against United. “We’ve been at this fight for PC-CP alongside Dr. Abels since 2004 when we took on his case against Blue Cross Blue Shield when the insurer refused to pay for PC-CP,” said Montoya. “We took that case against the Blues all the way to trial. The jury awarded us every dollar we asked for. We were affirmed by the Florida Supreme Court and that case made payment for PC-CP in Florida the law of the land,” Montoya said. “I commend Dr. Abels for continuing to carry the flag for pathologists and making sure that health insurance companies pay for this valuable and necessary medical service. I’m pleased that United stepped up and resolved this case to make pathologists whole for past and future payments.”

In an order entered on October 21, 2020, Judge Valerie Manno Schurr preliminarily approved the class action settlement and appointed Montoya as lead class counsel.

Montoya says he will continue his clients’ fight for PC-CP with cases currently pending for pathologists against Ambetter and United on other lines of business. He says more lawsuits will be filed shortly as health insurers continue to ignore the law. “We will continue to protect our pathologists’ rights in the Courts until the carriers get it right and recognize PC-CP as a valuable and necessary medical service.”

An update to this post can be found here.