{"id":33045,"date":"2026-01-05T11:05:35","date_gmt":"2026-01-05T15:05:35","guid":{"rendered":"https:\/\/red94.net\/news\/united-healthcare-faces-new-lawsuit-over-emergency-room-payment-rates-as-baptist-health-system-seeks-1-million-in-underpaid-claims\/"},"modified":"2026-01-05T11:05:35","modified_gmt":"2026-01-05T15:05:35","slug":"51413-united-healthcare-faces-new-lawsuit-over-emergency-room-payment-rates-for-hospit","status":"publish","type":"post","link":"https:\/\/red94.net\/news\/51413-united-healthcare-faces-new-lawsuit-over-emergency-room-payment-rates-for-hospit\/","title":{"rendered":"United Healthcare faces new lawsuit over emergency room payment rates as Baptist Health System seeks $1 million in underpaid claims"},"content":{"rendered":"

United Healthcare faces a new lawsuit over emergency room payment rates for hospitals. Baptist Health System of San Antonio<\/b> filed suit on December 22, 2025, alleging the insurer underpaid for emergency care. The lawsuit marks the latest in a growing number of disputes over how major insurance companies reimburse out-of-network hospital emergency departments.<\/p>\n

\n

\ud83d\udd25 Quick Facts<\/h3>\n
    \n
  • Baptist Health System<\/b> filed lawsuit on December 22, 2025, seeking reimbursement exceeding $1 million<\/b> for emergency services<\/li>\n
  • The hospitals claim United Healthcare reimbursed them at rates substantially below<\/b> the customary charges for out-of-network emergency care<\/li>\n
  • Seven acute-care hospitals and five Baptist Neighborhood Hospitals are part of the legal action<\/li>\n
  • The dispute stems from federal law requiring hospitals to provide emergency care regardless of insurance, but disagreement on payment rates persists<\/li>\n<\/ul>\n<\/div>\n

    Baptist Health System Files Six-Figure Emergency Room Dispute<\/h2>\n

    Baptist Health System of San Antonio<\/b> operates seven acute-care hospitals and five Baptist Neighborhood Hospitals across the region. The system owns and operates Baptist Medical Center<\/b>, North Central Baptist Hospital<\/b>, Northeast Baptist Hospital<\/b>, Mission Trail Baptist Hospital<\/b>, and St. Luke’s Baptist Hospital<\/b>.<\/p>\n

    The lawsuit was filed in state District Court in San Antonio against United Healthcare Insurance Co.<\/b> and UnitedHealthcare of Texas Inc.<\/b> The system claims it provided emergency medical services to United Healthcare members but was underpaid on the reimbursements. The actual dollar amount is not specified in the public filing but exceeds $1 million based on hospital claims.<\/p>\n

    How Out-of-Network Emergency Care Creates Payment Disputes<\/h2>\n

    United Healthcare creates financial incentives for members to use in-network providers by offering lower copayments and better coverage. When patients purchase health plans through insurance exchanges, they typically gain access to United Healthcare’s network hospitals at discounted rates.<\/p>\n

    However, federal law requires all hospitals to provide emergency care<\/b> to anyone who arrives with a medical emergency, regardless of whether they are in-network or have insurance. Baptist Health System argues this creates a fundamental problem: members use whichever hospital is closest during an emergency, which may not be in United Healthcare’s network.<\/p>\n

    According to the lawsuit, United Healthcare has “self-created a risk” by limiting network participation. When members present at out-of-network Baptist hospitals, the insurer is legally obligated to pay, but the two sides have been unable to agree on appropriate reimbursement rates.<\/p>\n

    Negotiation Breakdown Forces Hospital System to Court After Failed Mediation<\/h2>\n\n\n\n\n\n\n\n
    Dispute Factor<\/td>\nDetails<\/td>\n<\/tr>\n
    Dispute Amount<\/td>\nExceeds $1 million in underpaid claims<\/td>\n<\/tr>\n
    Claims Period<\/td>\nEmergency services provided after January 1, 2020<\/td>\n<\/tr>\n
    Mediation Attempt<\/td>\nNovember and December 2025 – 108 claims disputed<\/td>\n<\/tr>\n
    Settlement Result<\/td>\nUnable to reach agreement on appropriate reimbursement rate<\/td>\n<\/tr>\n
    Filing Date<\/td>\nDecember 22, 2025 in San Antonio state District Court<\/td>\n<\/tr>\n<\/table>\n

    Baptist Health System attempted to resolve the dispute through mediation in November and December 2025<\/b>. During this period, the parties reviewed 108 disputed claims<\/b> but were unable to reach a settlement on the appropriate reimbursement rate. The failed negotiations prompted Baptist Health System to file the lawsuit.<\/p>\n

    Baptist Health System Claims United Healthcare Systematically Underpays Emergency Services<\/h2>\n

    The lawsuit argues that because Baptist hospitals have no contract with United Healthcare for emergency care discounts, they are entitled to be paid the “usual and customary rate” for emergency medical care. Baptist Health System claims United Healthcare has reimbursed them at amounts “substantially below” those standard rates.<\/p>\n

    A spreadsheet detailing the alleged underpaid claims was submitted as evidence but was not publicly filed due to federal privacy protections. Alan Lash<\/b>, a Miami attorney representing the hospitals, did not respond to requests for comment.<\/p>\n

    United Healthcare did not respond to requests for comment on the lawsuit. The insurer has faced similar payment disputes from multiple healthcare providers across the country in recent years, including 17 HCA hospitals in Florida<\/b>, Ballad Health<\/b>, and various emergency medicine groups.<\/p>\n

    Are Other Hospitals and Providers Suing United Healthcare Over Emergency Room Reimbursement?<\/h2>\n

    Baptist Health System is not alone in challenging United Healthcare’s reimbursement practices. In February 2025<\/b>, 17 HCA hospitals in Florida sued United Healthcare, alleging they were underpaid for emergency services delivered to thousands of out-of-network patients. The healthcare industry has seen a surge in payment disputes between insurance carriers and hospital systems.<\/p>\n

    In addition to Baptist Health System’s case, Ballad Health<\/b> sued United Healthcare in October 2025 over Medicare Advantage payment practices, claiming the insurer failed to pay bed day claims and owes more than $7.1 million<\/b>. Meanwhile, other healthcare providers have named different insurers including Blue Cross and Blue Shield<\/b> in similar disputes over emergency care reimbursement.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":23,"featured_media":33044,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"schema_org_data":"{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Place\",\"name\":\"San Antonio\",\"description\":\"city\"},{\"@type\":\"Place\",\"name\":\"Miami\",\"description\":\"city\"}]}","_extracted_celebrities":"","_extracted_movies":"","_extracted_places":null,"_extracted_videos":"","_last_enrichment_date":"2026-01-05 11:06:17","footnotes":""},"categories":[391],"tags":[],"class_list":["post-33045","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-business-finance","generate-columns","tablet-grid-50","mobile-grid-100","grid-parent","grid-33"],"yoast_head":"\nUnited Healthcare faces new lawsuit over emergency room payment rates as Baptist Health System seeks $1 million in underpaid claims<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/red94.net\/news\/51413-united-healthcare-faces-new-lawsuit-over-emergency-room-payment-rates-for-hospit\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"United Healthcare faces new lawsuit over emergency room payment rates as Baptist Health System seeks $1 million in underpaid claims\" \/>\n<meta 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