Hospital Claims Kaiser Stiffed it for $23,500
5-25-2014 15:59:00

     MONTEREY, Calif. (CN) - A Monterey hospital claims in court that Kaiser Permanente stiffed it for $23,500 for a patient’s care.


     The Community Hospital of the Monterey Peninsula sued Kaiser Foundation Health Plan, and Kaiser Permanente Insurance, in Monterey County Court.

     According to the 7-page lawsuit, an unnamed patient was admitted to Community Hospital’s emergency room in October 2012 and spent four days in the hospital. The patient showed proof of his or her Kaiser coverage and all the treatment was medically necessary, the hospital claims in the complaint.

     “At the time of admission, Kaiser verified patient’s eligibility for health benefits provided by Community Hospital. During patient’s stay, Community Hospital contacted Kaiser to provide a clinical review of patient’s status and to obtain authorization for patient’s continued treatment. Kaiser refused to accept the clinical review over the telephone [and] refused to authorize or deny patient’s treatment,” the complaint states.

     When Community Hospital sent Kaiser a statement, “Kaiser denied Community Hospital’s claim for payment on the basis that Community Hospital failed to provide clinical review,” according to the complaint.

     Community Hospital appealed, but “Kaiser further denied payment to Community Hospital on the basis that, because clinical reviews were not received, the treatment provided to patient was not medically necessary,” the complaint states.

     The Community Hospital demands $23,499 plus 10 percent interest, a court order requiring Kaiser to pay for all emergency services Community Hospital provides to Kaiser’s members, a court order requiring Kaiser to pay Community Hospital’s billed charges and costs of suit.

     The Community Hospital is represented by Christopher E. Panetta and Elizabeth R. Leitzinger of Fenton & Keller in Monterey.

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