Home Criminal Defense Stanford Health Care seeks as much as $1.9M from Anthem in new...

Stanford Health Care seeks as much as $1.9M from Anthem in new go well with – MedCity News

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A serious West Coast supplier has sued a nationwide well being insurer for about $2 million in unpaid medical providers.

In a lawsuit filed final week, Palo Alto-based Stanford Health Care alleges that it offered look after six sufferers between 2018 and 2020 enrolled in a well being plan administered by Blue Cross Blue Shield Indiana. The supplier’s “usual and customary” expenses for the providers rendered totaled $2 million.

Indianapolis-based Anthem, as a licensee of the Blue Cross and Blue Shield Association, operates BCBS plans in 14 states, together with Indiana.

Per an implied contract between Anthem Blue Cross and Stanford, the supplier agreed to render care providers to its well being plan members, together with members of out-of-state associates as a part of the Blue Card Program, the lawsuit states.

BCBS Indiana is one such out-of-state affiliate and owes Stanford cost for the providers, in line with the lawsuit. Anthem declined to touch upon the litigation.

“Stanford Hospital’s rendering of medically necessary care to the patients was intended to, and did, benefit the patients, and therefore BCBS Indiana,” the lawsuit states.

The contract additionally features a discounted charge for the care offered by Stanford, which implies BCBS Indiana owed the supplier $294,173 of the $2 million in providers, the lawsuit claims. The insurer has solely paid $78,771.

But, because the contract is implied in actual fact, it’s unclear whether or not the court docket will decide that it’s legally binding. Such a contract is implied from information and circumstances that reveal a mutual intent to contract and isn’t particularly expressed in phrases, in line with the Legal Information Institute.

With regard to this lawsuit, there are two potential eventualities that might play out.

The first is one by which the court docket finds that the contract is legally enforceable. In this case, Stanford is searching for $215,000 plus interest.

But if the court docket determines that there isn’t a contractual relationship between Stanford and BCBS Indiana — making the lower cost void — the supplier is asking the insurer to pay the steadiness of $1.9 million for the sufferers’ care.

In both state of affairs, the supplier is asking to be reimbursed for all lawsuit-related prices incurred and another aid the court docket deems justifiable.

Photo: zimmytws, Getty Images

 

 

 

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