A group of physicians at Holyoke (Mass.) Medical Center is suing insurer Health New England over $2.5 million in reimbursements the company allegedly failed to pay for emergency room treatments, MassLive reported Oct. 4.
Health New England is the insurance arm of Springfield, Mass.-based Baystate Health. The lawsuit alleges Health New England has failed to make the reimbursements since July 2021 and claims the insurer stopped reimbursing the physicians even partially for treatment they rendered for hundreds of the company's members, according to the report.
The suit was filed by Lake National Emergency Physicians, a physician group that staffs Holyoke Medical Center's emergency department, according to the report. The group is considered out of network for Health New England members because the physicians do not have a contract with the insurance company. The insurer allegedly froze its payments after what the lawsuit alleges was a vague aduit. Health New England then allegedly demanded the company to turn over full medical records in order to receive reimbursements.
Health New England said in a statement shared with MassLive that the audit was triggered by a complaint from one of its members. The audit was conducted by a third party and "raised concerns about potential overbilling, as well as insufficient Lakes documentation to support the claims submitted."
The insurer said it "vigorously" contests the allegations and will defend itself against the lawsuit.