HELENA (AP) — A state judge has certified a class-action lawsuit against Benefis Health System in Great Falls over the hospital's billing practices.
Shannon Conway of Great Falls claims Benefis owes him money the hospital collected from an auto insurance policy over and above the amount his health insurance company was obliged to pay for his care under its preferred provider agreement with the hospital, the Great Falls Tribune (http://bit.ly/wXfS2l) reported Thursday.
District Judge Kenneth Neill granted class-action status to Conway's lawsuit on March 7, meaning others who claim Benefis collected medical payments in excess of their insurance carrier's negotiated rates can join the lawsuit.
Conway's lawsuit said he was in a car crash on July 29 and received medical care at Benefis at a cost of $2,074. At the time, Conway had medical coverage through TRICARE, the health insurance program for military personnel and retirees. Under Benefis' preferred provider contract with TRICARE, the company paid Benefis $663.
According to the lawsuit, Conway had also purchased a medical policy through his automobile insurance carrier, Kemper Preferred Insurance and was entitled to receive $1,866 from Kemper as a result of the crash.
Conway asked Kemper to pay the money to him, but the company sent it to the hospital. Benefis then returned the $633 to TRICARE and kept the Kemper payment.
The lawsuit claims Benefis defrauded Conway by keeping the larger payment from Kemper.
Benefis attorney David M. McLean said the hospital disagrees with the allegations, but declined further comment.
Conway's attorney, Zander Blewett, said the question before the court is whether Benefis is entitled to receive medical payments in excess of the negotiated reimbursement rates contained in preferred provider agreements.
"The hospital agreed in the preferred provider agreement that it would never take money from the patient greater than the reimbursement rate," Blewett said.
Benefis has 30 days to appeal the ruling granting class-action status.