A Kansas dentist has filed a lawsuit against several insurance companies alleging conspiracy to suppress out-of-network payments to healthcare providers.
Dennis Ayer, DDS, of Leawood, Kan., filed the lawsuit March 31 against Zelis Healthcare, UnitedHealth Group, Elevance Health, Aetna and The Cigna Group.
The dentist alleges that the companies used repricing strategies to underpay claims submitted by medical and dental providers for out-of-network services, according to court documents. These repricing practices inflicted financial harm by forcing providers to either lose money or decline care under these insurers, the dentist alleges. The insurers’ practices have also allegedly forced practices to merge with larger practices or consider closing down, limiting access to healthcare services.
The dentist’s legal team has requested that the case be certified as a class-action lawsuit and be given a jury trial.
A spokesperson for CVS Health, Aetna’s parent company, told Becker’s that the company does not comment on pending litigation.
A spokesperson for Zelis provided the following statement to Becker’s:
“The complaints filed against Zelis are without merit. They are mistaken about the identity of Zelis’ clients, the operation of Zelis’ solutions, and the benefits Zelis provides to patients, providers and health plans. Zelis provides highly customizable solutions that our clients leverage independently. Nothing about any of Zelis’ solutions is unlawful.
“The plaintiffs’ lawyers failed to conduct a diligent investigation before filing their claims. They copied allegations against another firm and concocted a ‘conspiracy’ among Zelis and health plans that is without any foundation in fact or law. Zelis looks forward to prevailing in court.”
Becker’s has reached out to UnitedHealth Group, Elevance Health and The Cigna Group for comment and will update this article if more information becomes available.
