Stu Erck, of Monticello, Minn.,has been refunded for his knee replacement procedure after filing a grievance with UnitedHealthcare for overbilling, according to an Aug. 30 report from The Minnesota Star Tribune.
Before undergoing a knee replacement, Mr. Erck confirmed that his facility, the St. Cloud Surgical Center, and his UnitedHealthcare Medicare Advantage plan would cover the operation in-network. St. Cloud Surgical Center and UnitedHealthcare are both owned by Minnetonka, Minn.-based UnitedHealth Group.
The facility and the insurer confirmed Mr. Erck would only pay $275 for the operation. More than six months after a successful operation, the surgery center said it actually had been out-of-network and Mr. Erck owed an additional $3,300. UnitedHealthcare continued to maintain the surgery center had been in-network.
While Mr. Erck disputed the charge, the surgery center sent his case to a debt collection agency that collected $1,800 from him.
In March 2024, after Mr. Erck's grievance was issued, UnitedHealthcare issued a ruling on the appeal, saying it had identified a clerical error.
Mr. Erck says that when he contacted the collection agency, they told him they hadn’t been cleared by the surgery center to issue a refund.
Mr. Erck then called the surgery center and heard that while it had received a payment from UnitedHealthcare, the facility didn’t receive information on how to process it.
Mr. Erck says he learned in subsequent calls that the surgery center was reluctant to have a refund issued because OptumCare wanted money back from the facility, according to the report.
In August, Mr. Erck finally received his refund from the collection agency and an apology from the St. Cloud Surgical Center.