Ballad Health accuses UHG of underpaying and delaying medically necessary patient care.
Ballad Health has taken a rare step by filing a federal lawsuit against United Healthcare Group, one of the largest insurance companies in the country. The case, brought in Greeneville, Tennessee, accuses United Healthcare Group of repeatedly denying, delaying, or underpaying for treatments that doctors had already deemed necessary. The health system also claims that the insurer exaggerated the health conditions of its Medicare Advantage members to receive higher government reimbursements.
The legal move represents the first time Ballad Health has ever sued an insurance company. Leaders at the organization said the lawsuit was a last resort, coming only after years of attempts to resolve disputes over payments and patient care practices. Ballad officials explained that United Healthcare Group’s behavior has made it harder for patients in rural regions to receive consistent care, while putting financial strain on community hospitals that already operate on narrow margins.
Ballad Health serves a wide swath of the Appalachian Highlands, a region where most residents rely on public programs or go without coverage. More than half of its patients are enrolled in Medicare, and most of those seniors are part of Medicare Advantage plans managed by United Healthcare Group. Because these patients depend heavily on those benefits, any disruption or delay in payments can ripple through hospitals, clinics, and long-term care facilities across the region.
Alan Levine, Ballad Health’s chairman and CEO, said the organization’s decision was not made lightly. He described the lawsuit as a necessary measure to protect both patients and providers. He said that United Healthcare Group’s pattern of underpayment and denial has made it difficult for doctors and hospitals to keep services available in rural communities, adding that those who depend on Medicare Advantage deserve the same access to treatment as anyone else.
Attorney Anthony Argiropoulos, who represents Ballad Health in the case, said United Healthcare Group’s conduct has had direct consequences for patients. He explained that by refusing to approve certain post-acute services, the insurer has forced hospitals to keep seniors longer than medically necessary. That creates overcrowding, raises the risk of hospital-acquired conditions, and increases costs for both patients and providers. Ballad officials added that United Healthcare Group had previously agreed to reimburse the health system for longer hospital stays but later failed to honor those commitments, withholding millions of dollars in payments.
The lawsuit also points to reports suggesting that United Healthcare Group’s subsidiaries have used questionable billing practices to boost their Medicare payments. According to Ballad Health, the insurer has been accused of overstating the severity of patients’ illnesses to collect more taxpayer money while simultaneously pressuring doctors to limit care and see more patients in less time. Ballad’s legal team said this creates a double standard that harms seniors and weakens the trust that federal programs rely on.
Levine emphasized that the health system’s focus remains on protecting access to care in small towns and rural areas. He said that when large insurance companies manipulate contracts or delay payments, the real burden falls on patients who must travel farther for treatment or wait longer for services. For hospitals already facing staffing shortages and financial strain, such practices can make it nearly impossible to maintain stability.
As part of the legal filing, Ballad Health announced that it will not renew its Medicare Advantage contract with United Healthcare Group when it expires in mid-2027. The decision does not affect United Healthcare Group’s other contracts with Ballad for commercial or Medicaid plans, which remain in place for now. Leaders said the choice was necessary to protect the system’s mission of keeping care local and ensuring hospitals remain open.
The case marks a significant moment for both healthcare providers and insurers. It raises questions about how Medicare Advantage plans are managed and whether insurers are living up to their obligations to patients and physicians. Ballad Health’s action may also encourage other rural health systems to speak out about the challenges they face when dealing with powerful insurance companies that control large portions of the healthcare market.
For Ballad Health, the message is clear: patient care and fair compensation must come before profit. The lawsuit signals a stand for accountability in a system where the balance between care and cost has become increasingly strained.
Sources:
Ballad sues UnitedHealth Group, alleges Medicare Advantage manipulation
Ballad Health Sues UnitedHealth Over Medicare Advantage Practices, Cites Post-Acute Care Denials
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