Kaiser Won’t Pay for Spine Surgeries, Provider Claims
VENTURA, Calif. (CN) – An emergency medical services provider claims Kaiser owes almost $475,000 for treating four of its patients, in Ventura County Superior Court.
San Jose Neurospine sued Kaiser Foundation Health Plan for breach of contract, unjust enrichment, unfair business practices, and bad faith.
San Jose specializes in emergency, minimally spine surgery, and accepts patients of many different health insurance providers, according to the complaint.
After treating four Kaiser patients at its facility, it says, it submitted timely and valid claims to Kaiser for reimbursement of medical costs, which totaled $542,000. Though Kaiser was obligated to honor these claims, it only paid out $67,057, leaving $474,942 remaining, the complaint states.
San Jose claims Kaiser punishes out-of-network providers like itself by underpaying them for medically necessary services covered under the patients’ policies and deliberately delaying the processing of claims in order to maximize its own profit while minimizing reimbursement costs.
Given Kaiser’s history of fraudulent behavior, San Jose says, seeking administrative remedies against it would be “futile.”
Worse yet, Kaiser’s failure to pay is harming San Jose’s business reputation and interfered with its relationship with patients, according to the complaint.
San Jose seeks the remaining balance of $474,942 plus interest on the principal sum at the rate of 15 percent per annum.
It is represented by Nicholas Van Parys of Westlake Village.