Hospital Claims Kaiser Stiffed it for $23,500
Calif. (CN) - A Monterey hospital
claims in court that Kaiser Permanente stiffed it for $23,500 for a patient’s
The Community Hospital of the Monterey Peninsula
sued Kaiser Foundation Health Plan, and Kaiser Permanente Insurance, in Monterey
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
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.