Class Action Challenges Oscar Health Over Breast Imaging Fees
HOUSTON, June 5, 2025 /PRNewswire/ -- On Wednesday, law firms Jeeves Mandel Law Group, P.C. and Milberg Coleman Bryson Phillips Grossman PLLC filed a class action lawsuit in federal court against Oscar Health Insurance, alleging the company violated Texas state law and its own insurance policies by requiring Texas female policyholders to pay deductibles and coinsurance for diagnostic breast imaging.
Following a January 1, 2022 update to Texas law, all medical insurers issuing non-ERISA medical insurance policies in Texas are required to pay 100% of the cost of their policyholders' diagnostic breast imaging – meaning no deductible, co-pays, or coinsurance.
Despite this update, the complaint contends Oscar continued to charge its insureds for part or all of the costs associated with such imaging. The complaint further alleges that besides economically harming the women covered by its policies, Oscar's violation of the law endangers their lives, as many may forego the imaging entirely because they are unable to bear the cost.
Excluding interest, the complaint alleges the amount in controversy exceeds $5 million, with the potential to reach $30 million considering statutory penalties, attorneys' fees, and additional costs.
Texas Law: Revised
Effective 2010, following the federal enactment of the Affordable Care Act ("ACA), all U.S. medical insurance policies are required to provide coverage for annual screening mammograms at no out-of-pocket cost to female patients 35 years of age and older.
In 2021, Texas amended Chapter 1356 of the Texas Insurance Code, requiring all policies issued or renewed in Texas on or after January 1, 2022 to provide coverage for diagnostic breast imaging "no less favorable" than the screening coverage delineated by the ACA.
The updated law also expanded the definition of "diagnostic imaging" to include mammography, ultrasound imaging, or magnetic resonance imaging used to evaluate abnormalities and certain individual criteria.
"For Insureds who have dense breast tissue, who have detected a lump or had their doctor detect one, who have had an abnormality show up on a screening mammogram, or who have a prior history of breast cancer, diagnostic breast imaging is a crucial tool to increase early detection and successful treatment of breast cancer," the complaint reads.
Oscar Health's Non-Compliance
While Oscar's written policies conform in part to Texas law and the ACA - providing coverage for mammogram screenings for women 35 and older at no cost - the complaint alleges the provider has failed to fully comply with the updated Texas statute by requiring its policyholders to pay all or part of the costs associated with diagnostic breast imaging.
According to the filing, even after January 1, 2022, Oscar continued forcing its insureds to pay 25% coinsurance after deductible for such imaging.
The filing further contends the deductible and/or coinsurance costs for insureds can range in the hundreds of dollars.
Lauren Moody, Class Plaintiff
The class is represented by Plaintiff Lauren Moody, who brought the suit on behalf of herself and similarly affected policyholders following her personal experience with Oscar.
In 2023, Moody underwent diagnostic breast imaging via ultrasound, which her doctor had ordered to evaluate a previously discovered abnormality.
The MRI company charged $578 for Moody's ultrasound.
In an Explanation of Benefits received the following month, Oscar allowed $161.22 of the charge and declared Moody responsible to pay 100% of that "Allowed Amount" towards her deductible.
Moody appealed Oscar's decision, citing the updated Texas Insurance Code provisions which require Oscar to pay 100% of the cost.
Oscar denied her appeal.
According to the complaint, Oscar "did not address Moody's contention that her Policy had been amended to conform to the Texas Insurance Code," further alleging the company, "did not make a good faith investigation of Moody's claim or have a reasonable basis for underpaying her claim and denying her appeal."
Ms. Moody explained her reasons for bringing a class action against Oscar. "By following my doctor's orders to have a diagnostic breast ultrasound, I did everything right. And still, Oscar made me pay. When Oscar denied my appeal even after I had pointed out the Texas law, I realized this was no mistake, it was a betrayal. I filed this lawsuit on behalf of every patient insured by Oscar whose wellbeing has been compromised by its violation of the law. We deserve the coverage we are legally entitled to receive."
Moody is one of thousands of women believed to have been harmed by Oscar's violation of Texas law.
About Jeeves Mandel Law Group, P.C. & Milberg Coleman Bryson Phillips Grossman
Represented by Roger L. Mandel of Jeeves Mandel Law Group and Greg Coleman of Milberg Coleman Bryson Phillips Grossman PLLC, the Class accuses Oscar of knowingly breaching its own policies and violating various provisions of the Texas Insurance Code.
According to Mr. Mandel, "The Texas Legislature passed the change in the law to make sure no Texas women with medical insurance would forego potentially life-saving diagnostic imaging because of its costs. By violating the law, Oscar is putting corporate profits above human lives."
"Compliance with the law is non-negotiable," says Mr. Coleman. "By shifting the cost of critical diagnostic imaging onto patients, Oscar has created life-threatening barriers to necessary healthcare… violating the law and its own policies in the process. We intend to hold Oscar – and similarly-operating insurers – fully accountable."
The lawsuit seeks to recover damages for affected policyholders' required payments, interest, and statutory penalties, as well as court costs, reasonable attorneys' fees, and expenses.
Jeeves Mandel Law Group has successfully represented victims of corporate wrongdoing across the country using class actions, recovering hundreds of millions of dollars. The firm seeks to protect the health, civil rights, and economic interests of its clients.
For over 50 years, Milberg and its affiliates have been fighting to protect victims' rights and have recovered over $50 billion for clients. A pioneer in class action litigation, Milberg is widely recognized as a leader in defending the rights of victims of corporate wrongdoing.
Oscar policyholders based in Texas - and patients covered by other insurers who were forced to pay all or part of the cost of diagnostic breast imaging - are encouraged to contact Milberg.
Media Contact:
Kaitlin Gagnon, Marketing Content Writer
Milberg Coleman Bryson Phillips Grossman PLLC
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SOURCE Milberg Coleman Bryson Phillips Grossman PLLC