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Insurance company and alleged breach of contract

People in New Jersey know that medical billing and insurance can be very complex. Every health insurance company makes agreements with select health care facilities and providers regarding what services they will provide coverage for and how much money they will pay on behalf of the patient for a given service. These negotiations can be complex and can have direct impact on the patients themselves as well as the medical providers or facilities. 

According to a report in NorthJersey.com, roughly five years ago the insurance company Amerigroup New Jersey entered into a contract with a hospital that was then called Paramus hospital to provide coverage for specific nursing services and also for detox services. Paramus hospital, now renamed the Bergen New Bridge Medical Center, is said to have provided the appropriate nursing services and the detox services to patients and then submitted reimbursement billing claims to the insurance company.

However, the hospital alleges that the insurer failed to provide payment as per the terms of their contract. As such, the owners of the hospital have initiated a lawsuit against Amerigroup New Jersey. They are seeking recourse for an alleged failure to pay more than $650,000 for nursing services and more than $1 million for detox services.

The lawsuit alleges not only breach of contract on the part of the insurance company but also consumer fraud and unjust enrichment. It is not known if the two parties will be able to come to a mutual settlement or if the suit will proceed to a full trial.

 

 

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