AllianceHealth Liens Against Patients Covered by Insurance Oklahoma Class Action

If you’re treated at a hospital that accepts your insurance, the hospital is supposed to submit its claims to your insurer, right? The complaint for this class action alleges that Community Health Systems, Inc. (CHS) doesn’t do this when patients are injured in auto accidents caused by a third party’s negligence. According to this complaint, instead of billing patient’s insurance company, CHS files a lien against the patient, in order to get higher fees.

CHS owns and operates a number of facilities that use the AllianceHealth name. It centralizes certain operations, including negotiating preferred provider agreements with insurance companies and patient billing.

Preferred provider agreements between insurers and hospitals or other providers state how much the insurance company will pay for treatments given to its insureds. The insurance company agrees to pay a certain fee for a service or treatment, and the provider agrees that the fee will be considered full payment, with no additional amount billed to the patient.

Although the negotiated fee will be lower than the hospital’s full price for the service or treatment, the agreements provide stability, because the hospital is sure of being paid promptly and many insureds will choose it precisely because it’s a preferred provider with their insurance company rather than an out-of-network facility that will cost them additional money.

However, the complaint alleges that CHS has a different billing practice for insured patients who are injured in an auto accident caused by the negligence of a third party. In such cases, the complaint says, “CHS and Alliance do not submit the patient’s medical bills to the patient’s health insurer.”

If they were to do this, they would have to accept the lower negotiated fee for their treatments. Instead, the complaint says, they seek to get their full fees: “CHS and Alliance have an undisclosed policy of filing liens against the [patients] injured…” They file the lien against the patient for any recovery from the third party for 100% of their full charges, not the lower negotiated rate. The complaint claims that patients are thus denied their insurance benefits: “The patient is left uninsured due to Defendants conduct.”

According to the complaint, “CHS has been sued three separate times for wrongfully refusing to submit a patient’s bill to the patient’s health insurance company.” It claims, “CHS has been told multiple times by multiple courts[] that its billing policy is harmful to its patients. Despite these court orders, CHS stubbornly continues to mandate the policy.”

Two classes have been defined for this action.

The first is all people in Oklahoma who, between October 21, 2014 to the present, were beneficiaries of an insurance plan from which CHS and Alliance had agreed to accept a reduced fee for services, but from whom CHS and Alliance demanded more than that reduced fee, and who paid more than the reduced fee.

The second is the same, but for people who have not paid more than the reduced fee.

Article Type: Lawsuit
Topic: medical
Tags: Medical Billing, Medical Care, Your Health