Mayo Clinic sues insurer over $740K in medical bills for patient
The Mayo Clinic is suing a health insurer, accusing the payer of failing to cover medical bills submitted for a patient who was in the hospital for 52 days, despite approving the care in advance.
In its claim, the nonprofit Mayo Clinic said Sanford Health Plan "approved and authorized all the days for healthcare goods and services” for the patient, who received care in 2022. The individual, referenced in the court filing as “C.G.,” was transferred from North Dakota to the primary Mayo Clinic campus in Rochester, Minnesota, to receive specialty care.
The Mayo Clinic is seeking nearly $740,000 to cover C.G.’s tab.
According to the complaint, Sanford paid several submitted claims for C.G. but has refused reimbursement for others, claiming the patient was covered by a different insurance plan, specifically a North Dakota Medicaid plan run by Blue Cross Blue Shield.
Sanford has also asked the Mayo Clinic to refund payment it made to cover C.G.’s stay at the campus. Mayo said it refunded these payments in “good faith” pending the outcome of its lawsuit.
“At no time during the dates that patient C.G. received inpatient healthcare goods and services at Mayo—or in any of the conversations or correspondences between Mayo and Sanford regarding patient C.G.’s care and approvals for the same—did Sanford represent that patient C.G. was actually insured through a tribal plan that Sanford was administering," the Mayo Clinic and its attorneys said in the lawsuit.
In its defense, Sanford claims it was the “payor of last resort” and not responsible for C.G.’s medical bills. Attempts to seek reimbursement from Blue Cross Blue Shield of North Dakota were denied due to a lack of prior authorization, the Mayo Clinic claims.
It maintains that it received prior approval and authorization from Sanford, accusing the insurer of "negligent and material misrepresentations" that have left $739,956.20 in medical expenses unpaid.
Sanford has declined to comment on the pending litigation.
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