UnitedHealth Group and Aetna were both named in lawsuits for allegedly denying claims and underpaying surgeons who provided advanced endometriosis treatment.
The lawsuits come from entities led by Tamer Seckin, MD, an endometriosis specialist, and Karli Goldstein, MD, who is a member of Dr. Seckin’s surgical team, according to the lawsuits, which were both filed Dec. 20. Both Dr. Seckin and Dr. Goldstein treated patients at New York City-based Lenox Hill Hospital.
The lawsuit targeting Aetna alleges the payer provided only $1,341 in reimbursement for a nearly $220,000 endometriosis treatment surgery. The underpayment was a result of not paying certain CPT codes, determining the laparoscopic surgery was not medically necessary, or failing to grasp the severity of endometriosis, according to the lawsuit.
The UnitedHealth Group lawsuit includes similar allegations, claiming that the payer only reimbursed about $3,900 of a $278,000 procedure for a patient with endometriosis, according to the lawsuit.
The complaint also alleges that Aetna failed to document the severity of the patient’s endometriosis, which spread to multiple organs.
UnitedHealth Group told Becker’s it would provide a statement once it is served the complaint.
Aetna did not respond to Becker’s request for comment.
This story will be updated as more information becomes available.