Baptist Hospitals says Humana not paying claims

By Annie Cosby | Dec 4, 2014

A hospital system is suing over claims an insurance company has failed to pay for patient care rendered.

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 Humana Insurance Company, citing breach of contract.

According to the complaint, the plaintiff has an agreement with the defendant whereby Baptist treats Humana's members at a negotiated discounted rate but Baptist says Humana has failed to pay for some services rendered.

Baptist says there were patients it treated in the emergency room and for in-patient care, and Humana authorized the care, representing the patients were covered, paid Baptist's claims but then reduced or recouped claims many months later on unsubstantiated claims of late medical records, no authorization, insufficient level of care, or medical necessity.

The complaint states Humana's excuses and delay of payment means the contractual discounts are no longer available, making Humana liable for more than $1.54 million. Humana is accused of breach of contract, negligence, negligent misrepresentation and insurance code violations.

The plaintiff seeks the more than $1 million owed, plus interest, attorney fees and costs of court. It is represented by attorney Lynne Sassi of Sullins, Johnston, Rohrbach and Magers in Houston.

Jefferson County District Court case number: D-196161

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