Neurosurgeon Claims Kaiser Shorted Him $60,000
3-8-2017 11:51:00

     SAN DIEGO (CN) – A neurosurgeon claims Kaiser owes $60,000 for emergency treatment services, in a complaint filed in San Diego County Superior Court.

           Pacific Neurosurgery & Spine Medical Group sued Kaiser Foundation Health Plan, alleging breach of contract, state Health and Safety Code violations, and violations of the California Business & Professions code.
            Dr. Sanjay Ghosh, Pacific Neurosurgery’s shareholder and director, is a board certified neurosurgeon who specializes in performing “complex surgeries of the head, neck, and skull base,” many of which are caused by trauma and require expensive, highly skilled treatment, according to the complaint.
            Specialists like Dr. Ghosh agree to serve on-call in hospital emergency rooms in case a patient requiring specialized treatment is admitted. They must treat such patients regardless of their insurance provider or ability to pay for services. Given this requirement, California law requires health plan providers to cover emergency room services, even if they are out of network, until the patient recovers.
            In January 2015, a Kaiser patient identified as S.F. was admitted to Scripps Memorial Hospital in La Jolla with a life-threatening injury. Dr. Ghosh, who has staff privileges at Scripps, was called in to perform emergency neurosurgery.
            Ghosh says he billed Kaiser $88,200 for the procedure, but has received just $27,835.21 to date.
            He claims Kaiser routinely pays out-of-network providers arbitrary sums far below the reasonable value of the medical treatments provided, enabling it to make a profit off of emergency services provided to its patients.
            Pacific Neurosurgery seeks $60,364 in restitution, as well as compensatory damages, prejudgment interest, and other court costs and fees.
            It is represented by attorney John Edwards.
37-2016-39067-CU-CO-CTL