On Monday a case was filed in the Middle District of Florida by Surgery Center of Viera against United Healthcare Insurance, Brookdale Senior Living Inc. and Brookdale Senior Living Welfare Plan. The case is regarding repricing and underpayment of a medical bill.
The plaintiff provided medical services for a patient who was insured through the Brookdale Senior Living Welfare Plan, which is administered by United Healthcare, according to the complaint.
The plaintiff received authorization to perform the services on behalf of the patient. The final billed charges were $193,438.00, however after processing by United Healthcare, a payment was made in the amount of $16,125.56. The plaintiff argues that there has never been an explanation of the large disparity between the billed charges and the payment made.
The plaintiff states that it appears a third party repricing system might have been used, but the defendants have failed to produce plan documents permitting such repricing under the patients plan. The plaintiff argues that the payment amount should have been 80% of billed charges per the contract in force at the time of services and argues that the payment amount represents a breach of that contract.
Plaintiff is suing for breach of contract, Unjust enrichment, and quantum meruit. Plaintiff is represented by Callagy Law.