Kaiser Owes for Medically Necessary Services, Hospital Says
8-14-2015 01:56:00

     SAN LUIS OBISPO, Calif. (CN) - Kaiser underpaid for medically necessary services Sierra Vista Hospital System provided to its patients, Sierra Vista claims in San Luis Obispo County Superior Court.

     Sierra Vista Hospital, Inc. dba Sierra Vista Regional Medical Center sued Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals for breach of written contract, breach of implied contract, unfair business practices, unjust enrichment and promissory estoppel.
     Sierra Vista, Kaiser and some other hospitals and health insurance plans are part of a network whose service agreement requires Sierra Vista to serve Kaiser members at discounted rates, according to the complaint. The agreement requires Kaiser to pay within 30 days and prohibits Kaiser from denying claims for medically necessary services, according to the complaint.
     Sierra Vista provided emergency care to three Kaiser patients, identified only as Patient 1, Patient 2 and Patient 3, according to the complaint. In all three cases, Kaiser claimed the patients were stable enough to have been transferred to a Kaiser facility for some of their treatment, according to the complaint.
     But Sierra Vista contends Kaiser made no effort to transfer them during their hospitalization, although Sierra Vista informed Kaiser and sought authorization to treat them as soon as it knew they were Kaiser members.
     Sierra Vista also claims the agreement states that clean claims not paid within 30 days are ineligible for the discounted rates, and that therefore Kaiser owes full the cost of the services, to the tune of $76,076.
     Sierra Vista Hospital seeks restitution for unjust enrichment, damages in quantum meruit, interest, costs and attorneys’ fees. Sierra Vista is represented by Jonathan F. Buck and Steven D. Sperling of the Helton Law Group in Huntington Beach.