Reimbursing pathology services maintains focus where it should be
February 24, 2026 – A consolidated group of pathologists in Florida is alleging that insurance provider United Healthcare, is either not paying or is severely underpaying their fees. On February 23, 2026, it was decided that the claim would continue in state court after a request by United Healthcare to move jurisdiction to federal court was denied.
“Today’s ruling is a vindication of pathologists’ right to have their state law claims heard by a jury in state court,” says co-counsel Patrick Montoya of Bryson Harris Suciu DeMay. “These pathologists have done over $120 million of work providing valuable, medically necessary patient care in the form of laboratory tests for over three years at hospitals throughout Florida, yet have not been paid by United Healthcare.”
The consolidated group of pathologists filed the claim in November 2023 against United Healthcare. They are represented by Montoya and Markus Kamberger of Byrson, and Steven Weinstein of K&L Gates.
Background
The pathology group provides medical services to hospitals that are insured by United Healthcare. In the 2023 filing, the group asserts that United Healthcare must compensate the pathology businesses, not the hospitals, for the professional clinical and anatomic pathology services provided, as this is consistent with how other pathology groups are compensated.
This pathology group does not have an agreement with United Healthcare but instead has a contract with the hospitals. However, they are not being paid by the hospitals, nor are they permitted to directly bill the patient. According to their contract with the hospital, they have the right to bill the patients’ insurance companies for services, while the hospital maintains the right to bill insurance companies for the technical component of pathology services. However, United Healthcare has continually failed to pay or has unreasonably underpaid the pathologists, even though their services are clearly covered.
The reimbursement issue stems from United Healthcare’s “commercial reimbursement policy,” which states that if a hospital contracts with an independent pathology group to render services, those services are only reimbursable to the facility.
State Court or Federal Court
United Healthcare sought to have the case permanently moved from state to federal court, arguing the claims are entirely preempted by the Employee Retirement Income Security Act of 1974 (ERISA), and that the right to payment requires interpretation of the patients’ health plans. United Healthcare noted there were thousands of disputed benefit claims, the majority of which were denied or otherwise not paid and identified three patients with ERISA-governed plans. United Healthcare claimed it was a coverage issue.
The pathology group disagreed. They indicated the action is based upon a dispute as to the rate of payment. The United Healthcare commercial reimbursement policy is clear that the services are covered and payment is required, but the company either made that payment to the wrong entity (the hospitals instead of the pathologists) or did not pay the amount in full.
The Court’s Decision
The court found that United Healthcare failed to show the case was preempted by ERISA. The case was remanded to the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida.
“This is a huge issue for patient care,” says Montoya. “If pathologists aren’t compensated, they will be forced to leave their jobs and the number of pathologists providing valuable, medically necessary patient care will be reduced. If pathologists aren’t reasonably compensated and pathologists leave the profession, laboratory test results will be slower, there will be more room for error, and patient care will suffer.”
Case No.: 23-cv-24927-JB