Ballad Health sues UnitedHealth Group, alleges pattern of denied and delayed care

GREENEVILLE, Tenn. — Ballad Health has filed a federal lawsuit against UnitedHealth Group, one of the nation's largest health insurers, alleging the company has systematically denied, delayed or underpaid for medically necessary care while inflating federal reimbursements through the Medicare Advantage program.

Filed in U.S. District Court in Greeneville, the suit marks the first time Ballad Health has taken legal action against an insurance company. The system said it made the decision only after years of unsuccessful attempts to resolve payment and patient care disputes.

"Taking legal action was our last resort," said Alan Levine, chairman and CEO of Ballad Health. "This is not our first choice; it's not a choice we've had to make before. But we had to take action because we believe UnitedHealth's behaviors are so harmful to patients, doctors and community hospitals."

Ballad Health serves a largely rural region across the Appalachian Highlands, where more than 75% of patients rely on government programs such as Medicare or Medicaid, or have no insurance at all. Roughly 55% of its patients are covered by Medicare, with nearly three-quarters enrolled in Medicare Advantage plans — most through UnitedHealth.

According to the lawsuit, UnitedHealth's denial of post-acute care for seniors has led to longer hospital stays, delayed discharges and increased strain on hospital capacity, raising costs for patients and hospitals. Ballad Health alleges that while UnitedHealth agreed to reimburse hospitals for prolonged inpatient care, it has failed to honor that commitment and withheld millions in payments.

"It's wrong to tell the federal government that patients are sicker to get more taxpayer money and then deny those same patients the care they need," said attorney Anthony Argiropoulos of Baker Donelson, who represents Ballad Health. "That behavior harms seniors, physicians and the very communities these programs are meant to serve."

Ballad Health announced it will not renew its Medicare Advantage contract with UnitedHealth when it expires June 30, 2027, though it will continue relationships under commercial, Medicaid and exchange plans.

"Rural systems like ours can't keep contracting with companies like UnitedHealth on Medicare Advantage when the math no longer works," Levine said. "Our mission is simple — to keep care local, keep hospitals open and ensure access to needed specialists and services."