Oklahoma City-based SSM Health is suing Bright Health over allegations that the insurtech has not paid for more than $13 million in medical claims.
The federal lawsuit was filed April 10 and claims that Bright owes SSM more than $13 million for medical services related to 2,541 patient claims filed for services that took place between Jan. 1 and Feb. 7.
In total, SSM says it provided more than $15.6 million worth of medical services to Bright members across multiple Oklahoma facilities. But because of recent business challenges and investigations from state insurance regulators, Bright exited all ACA markets across the country at the end of 2022, including Oklahoma.
"Because the parties do not have a contract, Bright is not entitled to discounted payment rates for the medical services provided by SSM to its enrollees, but instead is responsible for the reasonable and customary charges billed by SSM," the plaintiffs wrote.
Bright is currently being investigated and fined by insurance regulators in Oklahoma, Colorado, Texas, Tennessee and Florida, according to the suit.
SSM wants a jury trial and an order declaring that Bright breached an implied contract between the two organizations, along with "an award of damages … to make plaintiff whole," and interest, attorney fees, and additional costs.