Baptist Hospital seeks nearly $1.5M from insurance company

Annie Cosby Nov. 12, 2014, 9:59am

A hospital corporation is suing over claims an insurance company has improperly recouped claims payments and owes nearly $1.5 million.

Baptist Hospitals of Southeast Texas, doing business as Baptist Beaumont Hospital and Baptist Orange Hospital, filed a lawsuit Sept. 26 in Jefferson County District Court against Amerigroup Texas Inc., citing breach of contract.

According to the complaint, Baptist and Amerigroup, an insurance company, have a participating provider agreement whereby Baptist treats covered patients at a negotiated discounted rate and Amerigroup compensates Baptist no later than 30 days following the receipt of the claim.

Baptist says there are instances in which it admitted patients, verified their covered status with Amerigroup, treated the patients and submitted claims, and then Amerigroup made payment only, many months later, to reduce or recoup the payments.

The complaint states that in many cases, Amerigroup cited medical necessity, level of care, lack of notification and appeals not timely filed, despite even though the majority of patients were emergently admitted and Amerigroup is, under the agreement, responsible for payment of emergency room services.

Baptist says because of Amerigroup's failure to timely pay the contractual amount, the contractual discounts are no longer available, and Amerigroup is liable for late-payment interest, making the balance due to Baptist more than $1,429,127.

Amerigroup is accused of breach of contract and negligence and negligent misrepresentation. Baptist seeks the more than $1 million in actual damages plus interest and attorney fees.

It is represented by attorney Lynne Sassi of Sullins, Johnston, Rohrbach and Magers in Houston.

Jefferson County District Court case number: E-196159

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