A lawsuit accusing UnitedHealthcare of shorting out-of-network pathology providers more than $100 million in reimbursements has been remanded to state court after a Florida federal judge ruled the insurer failed to establish a valid claim under the Employee Retirement Insurance Security Act of 1974 (ERISA).
In an order from the US District Court for the Southern District of Florida, the court sent back a consolidated action brought by pathology groups alleging UnitedHealthcare routinely failed to pay, or significantly underpaid, for services that are otherwise covered under patients' health plans.
UnitedHealthcare argued that ERISA preemption applied because at least three of the patients' plans cited in the complained were governed by ERISA. The insurer contended that the providers were effectively seeking plan benefits and should have to prove that the services were covered and medically necessary under those ERISA plans.
The providers countered that a jury trial in state court was warranted because their claims arise under Florida statutes and common law. They also challenged the company's payment methodology and rate, not entitlements to benefits. They also argued that the claim reviews were inconsistent with the language of individual plan documents.
The court held that the assignments of benefits relied on by the plaintiffs did not come from patients who themselves had standing to sue under ERISA because, under Florida's balance billing restrictions, those patients were never personally liable for the disputed amounts. With no underlying ERISA standing, there were no ERISA rights for patients to assign to the providers. As a result, UnitedHealthcare could not rely on federal-question jurisdiction and the case was remanded to state court.
Pattern of out-of-network disputes
The decision comes against a backdrop of mounting out-of-network disputes for UnitedHealthcare. In February 2025, 17 HCA Healthcare hospitals in Florida filed suit alleging roughly $145 million in underpayments for emergency services provided to the company's members treated out of network, arguing the insurer reimbursed below market rates for thousands of claims.
In Nevada, the state’s supreme court last year narrowed, but largely upheld, a jury finding that the company had been unjustly enriched by underpaying emergency provider TeamHealth for out-of-network ER services after their contract lapsed, even as it struck down large portions of a $60 million punitive damages award and related statutory claims.
At the same time, UnitedHealthcare is pursuing its own litigation against providers. In August 2025, the insurer sued Radiology Partners and an Arizona affiliate, alleging they misused the No Surprises Act’s independent dispute resolution process by routing in-network work through an out-of-network entity to trigger higher arbitration awards. That case underscores how payers and providers are testing the boundaries of new federal protections on surprise billing alongside longstanding out-of-network reimbursement fights.
Financially, the remand comes at a challenging moment for parent company UnitedHealth Group. The group reported 2024 net income of $14.4 billion but profits were hit by higher medical costs and the fallout from the Change Healthcare cyberattack, leaving 2024 earnings at their lowest level in five years.
In Q4 2025, net income dropped to just $10 million from $5.54 billion a year earlier, driven by a $1.6 billion after-tax charge related to Change and restructuring, even as quarterly revenue climbed to $113.2 billion.
Ratings agencies have also begun to reflect those pressures. In mid‑2025, AM Best revised UnitedHealth Group’s credit ratings outlook from stable to negative on concerns over Medicare Advantage performance, while affirming an A+ (Superior) financial strength rating for key subsidiaries on the basis of a strong balance sheet and very strong operating performance.
