Aug. 20—Wellstar Health System filed a lawsuit against Kaiser Permanente this week seeking tens of millions of dollars from what Wellstar says are years of unpaid insurance claims.
The suit, filed in Gwinnett County Superior Court, alleges Kaiser has either failed to pay for healthcare services provided by Wellstar to patients with Kaiser insurance, or assessed significant "unauthorized discounts" on those services. The charges began accumulating in 2017, according to a copy of the complaint, and Wellstar has received "zero dollars" for all services provided to Kaiser members since January 2021.
Representatives for Wellstar did not return requests for comment from the MDJ. The healthcare giant did, however, include over 150 pages of balance sheets in its filing to illustrate the back payments due.
One such sheet shows a total of $18.4 million in unpaid claims in the first three months of 2021 alone. The "unauthorized reductions," which Wellstar says average out to a roughly 20% discount on healthcare services, were "unilaterally" assessed by Kaiser and total another $22.6 million.
"Wellstar has repeatedly asked Kaiser to make these payments ... but Kaiser has refused to pay Wellstar these owed amounts," the filing reads in part.
On top of the unpaid claims, Wellstar says it is entitled by state law to a 12% per year interest rate on the balance and is seeking to have its litigation costs covered as well.
In response to the suit, Kaiser Permanente Georgia issued the following statement:
"Unfortunately, insurer disputes with hospitals over reimbursement have become all too common in today's healthcare environment. We had been in communication with WellStar to resolve these issues in a fair and equitable way and in accordance with the law. Since they have chosen to file this lawsuit, we look forward to presenting all of the facts in court.
"Our interest is in paying fairly for the services our members receive through their emergency department and protecting our members from balance billing. We have been paying claims in this market for 36 years and will do the same with WellStar once the disputed issues are resolved."