Allegheny County company sues hospital, insurance plan

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A Richland Township, Pa., dialysis company is suing a local hospital and its health insurance plan for $950,000, the amount it says is owed to pay the full benefits of two of its patients.

medical-casePhysicians Dialysis Acquisitions Inc. is suing Conemaugh Health Systems of Johnstown, Pa., located east of Pittsburgh, and its Health and Welfare Benefit Plan, on behalf of one of its subsidiaries, DaVita PDI-Johnstown, according to the Johnstown Tribune-Democrat.

The suit, filed in the Pennsylvania Western District Court in Pittsburgh, alleges that the hospital’s Health and Welfare Benefit Plan “has engaged in a practice of providing inadequate benefits for out-of-network services,” the paper reported. This strategy aimed “to increase the costs of its members going out-of-network,” therefore swaying members from using out-of-network providers.

For one of the patients in the lawsuit, the dialysis company billed $581,000 for services and believes the plan should cover $521,000, but only paid $38,000.

A spokeswoman for the hospital did not comment on the pending litigation, in which the dialysis company seeks to have the bills paid with interest and attorney fees covered as well.

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