New York hospital suing insurance plan over millions in reimbursement

Massena (N.Y.) Memorial Hospital filed additional claims against an employer health plan in an ongoing legal battle over reimbursement, according to the Watertown Daily Times.

Four things to know:

1. In its latest filing against the St. Lawrence-Lewis Counties School District Employees Medical Plan, Massena Memorial accused the insurance plan of owing the hospital more than $2.4 million from 2017-18. The filing was dated Dec. 10, 2018.

2. The filing is part of a legal battle that began in August 2017 between the health plan, which covers nearly 10,000 teachers, and the hospital. Initially, Massena Memorial claimed the health plan had not paid for nearly $3.7 million in reimbursements under a 1997 agreement the two organizations penned, according to the report.

3. The 20-year-old agreement requires the plan to pay 92 percent of all outpatient service costs charged by the hospital. While the health plan argues it has paid according to the formula, the hospital disagrees.

4. The next phase of the legal process will be a discovery one, which representatives from St. Lawrence-Lewis predict could last a year or more due to the number of claims that need review, according to the Watertown Daily Times.

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